Enjuagues bucales convencionales y herbales en el tratamiento de la enfermedad periodontal / Conventional and Herbal Mouthwashes in the Treatment of Periodontal Disease

Introducción: Existen datos controversiales y pocas revisiones acerca del efecto de los enjuagues herbales como complemento en la higiene bucal de pacientes con enfermedad periodontal. La reducción en costos y efectos secundarios de estos enjuagues, en comparación con los convencionales, los colocan en una posición prometedora para el cuidado de la salud. Objetivo: Comparar el efecto de los enjuagues bucales convencionales con los enjuagues herbales en la mejora de los siguientes parámetros periodontales: índice gingival, de placa, sangrado al sondaje, profundidad al sondaje y nivel de adherencia clínica en pacientes adultos con gingivitis o periodontitis. Métodos: Se realizó la revisión en las bases de datos MEDLINE/PubMed, Scopus, Web of Science, BVS y EBSCO, para identificar ensayos clínicos donde se comparen enjuagues bucales comerciales vs. herbales, publicados entre 2018 y 2022. Siguiendo las recomendaciones PRISMA, se utilizó el sistema PICO para determinar la pregunta clínica y una ecuación de búsqueda con criterios de elegibilidad. Resultados: De 485 estudios identificados inicialmente se analizaron 25 ensayos clínicos, de los cuales la mayoría se realizaron en la India (11) y en pacientes sin problemas sistémicos (23). Las muestras evaluadas fueron desde 19 hasta 318 sujetos, con edades comprendidas entre 18 y 74 años. El menor tiempo de seguimiento fue de siete días y el mayor de 180 días. Con respecto a los enjuagues evaluados, 20 ensayos usaron clorhexidina y 18 enjuagues a base de plantas herbáceas. Así mismo, seis estudios reportaron efectos adversos y tres reportaron conflictos de interés. Conclusiones: Los aceites esenciales combinados con curcumina redujeron el índice de placa en mayor medida que el enjuague de clorhexidina, que es el estándar dorado. Así mismo, la mayoría de los enjuagues herbales estudiados tuvieron un efecto similar a este último para mejorar los parámetros periodontales(AU)

Introduction: There are controversial data and few reviews about the effect of herbal rinses as an adjunct in oral hygiene in patients with periodontal disease. The reduction in costs and side effects of these rinses, in comparison with conventional rinses, place them in a promising position for health care. Objective: To compare the effect of conventional mouthwashes with herbal rinses in the improvement of the following periodontal parameters: gingival index, plaque index, bleeding on probing, probing depth and level of clinical adherence in adult patients with gingivitis or periodontitis. Methods: A review was performed in MEDLINE/PubMed, Scopus, Web of Science, BVS and EBSCO databases to identify clinical trials comparing commercial vs. herbal mouthrinses, published between 2018 and 2022. Following PRISMA recommendations, the PICO system was used to determine the clinical question and a search equation with eligibility criteria. Results: Out of 485 studies initially identified, 25 clinical trials were analyzed, of which the majority were conducted in India (11) and in patients without systemic problems (23). The samples evaluated ranged from 19 to 318 subjects, aged 18-74 years. The shortest follow-up time was seven days and the longest was 180 days. Regarding the rinses evaluated, 20 trials used chlorhexidine and 18 used herbal rinses. Also, six studies reported adverse effects and three reported conflicts of interest. Conclusions: Essential oils combined with curcumin reduced plaque index to a greater extent than the gold standard chlorhexidine rinse. Most of the herbal rinses studied had a similar effect to the latter in improving periodontal parameters(AU)

Vulnerabilidade socioeconômica e microcefalia relacionada ao Zika vírus no Brasil / Socioeconomic vulnerability and microcephaly related to Zika virus in Brazil

Resumo Objetivo: Realizar uma análise descritiva dos gastos privados diretos domiciliares em saúde e da vulnerabilidade socioeconômica associados à condição de microcefalia, uma das manifestações mais evidentes da síndrome congênita do Zika vírus (SCZ). O surto de microcefalia e outros distúrbios neurológicos em crianças menores de um ano de idade foi associado à infecção pelo vírus Zika, durante a epidemia ocorrida no período de 2015-2016 no Brasil. Método: Noventa e seis entrevistas foram realizadas em dois centros especializados de atendimento às crianças acometidas por microcefalia nas cidades do Rio de Janeiro e Fortaleza. O questionário estruturado abrangeu características sociodemográficas, gastos com desembolso direto associados com a doença e estratégias adotadas pelas famílias para lidarem com os desafios financeiros impostos pela anomalia congênita. Resultados: Os domicílios eram majoritariamente chefiados por não-brancos e pertenciam às classes C e D-E. Os gastos com medicamentos contabilizaram 78% dos gastos médicos, enquanto as despesas com transporte representaram 46% do gasto privado não-médico. A maioria dos domicílios enfrentaram endividamento e redução do consumo doméstico, inclusive de alimentos, a fim de fazer face às despesas incorridas pela doença. Conclusão: A microcefalia parece reforçar a vulnerabilidade socioeconômica das famílias, reforçando o círculo vicioso característico da abordagem conceitual da armadilha saúde-pobreza.

Abstract Objective: To carry out a descriptive analysis of direct private household health expenditures and socioeconomic vulnerability associated with the condition of Microcephaly, one of the most evidence manifestations of Congenital Zika Syndrome (CZS). The outbreak of microcephaly and other neurological disorders in children under one year of age was linked to Zika virus infection during the 2015-2016 epidemic in Brazil. Method: Ninety-six interviews were carried out in two specialized care centers for children with microcephaly in the cities of Rio de Janeiro and Fortaleza, Brazil. The structured questionnaire covered sociodemographic characteristics, out-of-pocket expenditures associated with the disease, and strategies adopted by families to deal with the financial challenges imposed by the congenital anomaly. Results: The households were mostly headed by non-whites and belonged to classes C and D-E. Expenditures on medicines accounted for 78% of medical expenses, while transportation represented 46% of private non-medical expenses. Most households faced debt and reduced domestic consumption, including food, to meet the expenses incurred by the disease. Conclusion: Microcephaly appears to reinforce the socioeconomic vulnerability of families, reinforcing the vicious circle characteristic of the health-poverty trap conceptual approach.

Unvaccinated periodontal patients with a history of COVID-19: clinical findings in a Dental School setting

Abstract This study analyzed the periodontal clinical data of individuals with a history of COVID-19 treated in a dental school during the pandemic in 2021 before vaccination. Methods: This analysis included individuals older than 18 years with no history of systemic disorders other than systemic arterial hypertension. Individuals who had COVID-19 were classified according to the World Health Organization as asymptomatic, with mild, moderate, severe, or critical symptoms. Results: A total of 95 individuals were evaluated, which included 24 with a history of COVID-19. Seventeen percent had been asymptomatic, 21% had mild, 25% moderate, 21% severe, and 17% critical symptoms, including intubation. Individuals with no history of COVID-19 presented significantly lower measurements of probing depth (p=0.003; Mann-Whitney test) and clinical attachment level (p=0.002) compared to individuals with a history of COVID-19. A significant negative association was found between bleeding on probing and the severity of characteristics of COVID-19 (rho= -0.233; p=0.023). Conversely, positive associations between the values of probing depth (rho= 0.292; p=0.004) and mean clinical attachment level (rho= 0.300; p=0.003) and the characteristics of COVID-19 were found. Conclusions: The periodontal data shows that patients who had COVID-19 before vaccination may present a worse periodontal status when compared to patients in the same clinical setting with no history of COVID-19. However, a more extensive study should confirm it with more participants.

Resumo Este estudo analisou os dados clínicos periodontais de indivíduos com histórico de COVID-19 tratados em uma escola de odontologia durante a pandemia em 2021, antes da vacinação. Métodos: Essa análise incluiu indivíduos maiores de 18 anos sem histórico de distúrbios sistêmicos, exceto hipertensão arterial sistêmica. Os indivíduos que tiveram COVID-19 foram classificados de acordo com a Organização Mundial da Saúde como assintomáticos, com sintomas leves, moderados, graves ou críticos. Resultados: 95 indivíduos foram avaliados, incluindo 24 com histórico de COVID-19. 17% eram assintomáticos, 21% tinham sintomas leves, 25% moderados, 21% graves e 17% críticos, incluindo intubação. Os indivíduos sem histórico de COVID-19 apresentaram medidas significativamente mais baixas de profundidade de sondagem (p=0,003; teste de Mann-Whitney) e nível de fixação clínica (p=0,002) em comparação com indivíduos com histórico de COVID-19. Foi encontrada uma associação negativa significativa entre o sangramento à sondagem e a gravidade das características da COVID-19 (rho= -0,233; p=0,023). Por outro lado, foram encontradas associações positivas entre os valores de profundidade de sondagem (rho = 0,292; p = 0,004) e o nível médio de apego clínico (rho = 0,300; p = 0,003) e as características da COVID-19. Conclusão: Os dados periodontais mostraram que os pacientes que tiveram COVID-19 antes da vacinação podem apresentar um pior estado periodontal quando comparados a pacientes no mesmo ambiente clínico sem histórico de COVID-19. No entanto, um estudo mais extenso deve ser realizado para confirmar tal achado com maior número de participantes.

Tratamento de periodontite estágio III localizado grau C em um indivíduo fumante: um relato de caso / Treatment of periodontitis stage III localized grade C in smoker individual: a case report

Objetivo: A periodontite é uma doença infecto-inflamatória que acomete os tecidos de inserção periodontal, e ser fumante representa um risco modificável significativo para todos os graus da doença. Ainda, indivíduos fumantes apresentam uma resposta inflamatória alterada quando comparados a não fumantes. Nesse contexto, o objetivo deste estudo foi reportar um relato de caso de tratamento periodontal de paciente fumante pesado. Relato de caso: O paciente DRS, sexo masculino, 22 anos, foi encaminhado à Faculdade de Odontologia da Universidade Federal de Pelotas (UFPel) com a queixa principal de necessidade de "realização de uma limpeza dentária". Na anamnese, relatou fumar 20 cigarros ao dia, há 7 anos (7 maços-ano). Na consulta inicial, foi encontrado índice de placa visível (IPV) de 100% e índice de sangramento gengival (ISG) de 66,67%. Foi encontrado cálculo supragengival como fator retentivo de placa (FRP) em 46,30% dos sítios. Estabeleceu-se o diagnóstico de periodontite estágio III localizado grau C. Os exames periodontais foram realizados por um único pesquisador calibrado e optou-se pelo tratamento periodontal não cirúrgico. Ao exame de 12 meses, o paciente apresentou IPV de 23,45% e ISG de 22,83%. Houve ausência de FRP. De uma forma geral, foi possível constatar a diminuição significativa das bolsas periodontais, bem como o ganho significativo de inserção clínica periodontal. Considerações finais: Dessa forma, é possível concluir a efetividade da terapia periodontal não cirúrgica, aliada à manutenção periodontal e instruções de higiene para o tratamento de periodontite estágio III, grau C, em paciente fumante.(AU)

Objective: Periodontitis is an infect-inflammatory diseases that affects the periodontal attachment tissues, and being smoker represents a significant modifiable risk for all degrees of the disease. Moreover, smokers have an altered inflammatory response when compared to non-smokers. Therefore, the aim of this study was to report a case report of periodontal treatment of a heavy smoker. Case report: A patient DRS, male, 22 years old, was referred to the School of Dentistry of the Federal University of Pelotas (UFPel) with the main complaint of the need to "perform a dental cleaning". During the anamnesis, he reported smoking 20 cigarettes a day for 7 years (7 pack-years). In the initial appointment, a visible plaque index (VPI) of 100% and a gingival bleeding index (GBI) of 66.67% were found. Supragingival calculus was found as a plaque retentive factor (PRF) in 46.30% of the sites. The diagnosis of periodontitis stage III localized grade C was established. Periodontal examinations were performed by a single calibrated researcher and non-surgical periodontal treatment was chosen. At the 12-month appointment, the patient had an VPI of 23.45% and an GBI of 22.83%. There was absence of PRF. In general, it was possible to observe a significant decrease in periodontal pockets, as well as a significant gain in periodontal clinical attachment. Final considerations: Thus, it is possible to conclude the effectiveness of non-surgical periodontal therapy, combined with periodontal maintenance and hygiene instructions for the treatment of periodontitis stage III localized grade C in a smoker.(AU)

A long-term clinical outcome of Hoffmann pocket four-point scleral fixated intraocular lens implantation combined with penetrating keratoplasty – A single corneal surgeon’s report

Purpose: To analyze retrospectively the outcomes of Hoffmann pocket scleral fixated intraocular lens implantation combined with penetrating keratoplasty at a tertiary institute by a single corneal surgeon. Methods: Forty?two eyes of 42 patients, aged between 11 and 84 years, had a mean follow?up of 2 ± 2.216 years. Overall, five (11.9%) had congenital and 37 had acquired pathology, 15 were pseudophakic, 23 were aphakic, and four were phakic. The commonest indication was trauma in 19 (45.2%), and 21 had previous multiple surgeries including five retinal procedures. Results: The grafts were clear in 20 (47.6%), they failed in 20, three had acute rejection, three were ectatic, two had infection, one had persistent edema, and one had endophthalmitis. The mean log of minimum angle of resolution (logMAR) best corrected visual acuity was 1.902 pre?op, 1.802 at the final follow?up, and 0.52 after excluding preexisting retinal pathologies. At the last follow?up, the vision improved in 18 (42.9%), maintained in 6, and worsened in 18, and three needed more than ?5.00 D and seven needed more than ?3.00 D cylinder correction. Five had glaucoma preoperatively, 10 developed the condition postoperatively, six needed cyclodestructive procedure, and three had valve surgery. Conclusion: Advantages of this surgery are avoidance of additional sections to insert the lens, direct positioning of the lens in the posterior chamber, rotational stability of the lens from four?point fixation, and untouched conjunctiva over the scleral pockets. The fact that 20 had clear grafts and 18 visually improved, though two needed lens removal and one developed retinal detachment postsurgery is encouraging. More cases with longer follow?ups will help understand the technique better

Cost of screening, out-of-pocket expenditure & quality of life for diabetes & hypertension in India

Background & objectives: The Government of India has initiated a population based screening (PBS) for noncommunicable diseases (NCDs). A health technology assessment agency in India commissioned a study to assess the cost-effectiveness of screening diabetes and hypertension. The present study was undertaken to estimate the cost of PBS for Type II diabetes and hypertension. Second, out-of-pocket expenditure (OOPE) for outpatient care and health-related quality of life (HRQoL) among diabetes and hypertension patients were estimated. Methods: Economic cost of PBS of diabetes and hypertension was assessed using micro-costing methodology from a health system perspective in two States. A total of 165 outpatients with diabetes, 300 with hypertension and 497 with both were recruited to collect data on OOPE and HRQoL. Results: On coverage of 50 per cent, the PBS of diabetes and hypertension incurred a cost of ? 45.2 per person screened. The mean OOPE on outpatient consultation for a patient with diabetes, hypertension and both diabetes and hypertension was ? 4381 (95% confidence interval [CI]: 3786-4976), ? 1427 (95% CI: 1278-1576) and ? 3932 (95% CI: 3614-4250), respectively. Catastrophic health expenditure was incurred by 20, 1.3 and 14.8 per cent of patients with diabetes, hypertension and both diabetes and hypertension, respectively. The mean HRQoL score of patients with diabetes, hypertension and both was 0.76 (95% CI: 0.72-0.8), 0.89 (95% CI: 0.87-0.91) and 0.68 (95% CI: 0.66-0.7), respectively. Interpretations & conclusions: The findings of our study are useful for assessing cost-effectiveness of screening strategies for diabetes and hypertension.

Out of Pocket Expenditure among Cancer Patients Availing Treatment at A Tertiary Care Centre in Hyderabad, India

Background: The expenses that the patient or the family pays directly to the health care provider, without a third-party (insurer or State) is known as 'Out of Pocket Expenditure' (OOPE). These expenses could be medi-cal and non-medical. About 150 million people face financial catastrophe every year due to health care pay-ments and cancer is one of the leading causes of high OOPE. Objectives: This study was conducted to estimate the OOPE among cancer patients and to determine the OOPE in relation to type of cancer and treatment modality.Methodology: A cross sectional study was conducted at a tertiary care centre in Hyderabad during August and September,2022 with a total study population of 400 cancer patients. After consenting the participants, data was collected via face-to-face interview using a semi structured questionnaire. Results: The mean OOPE per patient was found to be $1032.65 (₹84,643.20). This includes the medical and non-medical costs. Leukaemia was found to have the highest OOPE amongst all cancers followed by colon cancer. Similarly, radiotherapy + surgery was found to have the highest OOPE followed by chemotherapy + radiotherapy + surgery.Conclusion And Interpretation- This study is unique in its way that no other study has considered OOPE for different cancers in single research. We would like to highlight the quantification of OOPE among various types of cancers and its variation based on treatment modality used. It is necessary that future government in-itiatives consider the importance of mitigating the OOPE along with provision of cancer care.

Expenditure Incurred by Patients of Pulmonary and Extrapulmonary Tuberculosis Under Revised National Tuberculosis Control Programme in District Tuberculosis Center, Jammu

Background: Tuberculosis (TB) patients suffer enormously due to huge cost on diagnosis and treatment. This study aims to assess the total expenditure and its predictors among patients of TB. Methodology: A longitudinal study was conducted among TB Patients registered in first quarter of 2018 at District Tuberculosis Center, Jammu. Data was collected by interviewing the patients and their attendants. Statistical significance of median expenditure between patients of pulmonary and extrapulmonary TB in rela-tion to various predictors was assessed using nonparametric tests followed by Multiple Linear Regression. Results: Total median cost, median direct and indirect cost incurred by a TB patient were recorded as USD 489.55, USD 246.55 and USD 229.5 respectively. Treatment costs were slightly higher in patients of pulmo-nary TB in comparison to extrapulmonary TB (p>0.05). On bivariate analysis, upper class, previously treated patients, Category 2 patients, with chronic illnesses, with guardians and who were employed expended signif-icantly higher amounts on their treatment, but on multivariate analysis, only formal employment, current earning and being reimbursed significantly predicted the total cost (p < .001, adjusted R square = 0.56). Conclusion: Huge direct costs incurred by patients is a matter of great concern, more so as the Indian gov-ernment has made all diagnostics and treatment free since the inception of the RNTCP.

Radiografía al acceso en artroplastia de rodilla entre los beneficiarios del Fondo Nacional de Salud entre 2004 y 2021 / Access to knee arthroplasty among National Health Fund beneficiaries in Chile between 2004 and 2021

INTRODUCCIÓN: La artrosis de rodilla es una patología que afecta la calidad de vida, siendo la artroplastía de rodilla un tratamiento costo-efectivo para la etapa severa de esta enfermedad. El acceso a artroplastia de rodilla es un indicador de salud de la Organización de Cooperación y Desarrollo Económico. Los objetivos de este estudio son determinar la incidencia de artroplastia de rodilla entre 2004 y 2021 en los beneficiarios del Fondo Nacional de Salud en Chile, la proporción que se operaron en el sistema privado y estimar el gasto del bolsillo del paciente para operarse. MÉTODO: Estudio transversal. Se utilizó la base de datos del Departamento de Estadística e Información de Salud. Se pesquisaron pacientes que egresaron de un centro de salud chileno que fueron intervenidos por artroplastia rodilla entre 2004 y 2021. Se analizó la proporción de pacientes por tramo del Fondo Nacional de Salud y si se realizó su cirugía en establecimiento de la red pública o privada. RESULTADOS: De las 31 526 intervenciones de artroplastia de rodilla, 21 248 (67,38%) fueron realizadas en pacientes del Fondo Nacional de Salud y 16 238 en instituciones públicas (51,49%). Los pacientes de dicho fondo presentan un alza sistemática en el volumen de artroplastías de rodilla hasta 2019, pero disminuyeron en 2020 y 2021 un 68% y un 51%. Del total de pacientes del sistema público operados de artroplastia de rodilla, 856 (9%) pertenecían al tramo A1, al tramo B 12 806 (60%), al tramo C 2044 (10%) y al tramo D 4421 (21%). Se estimó que el gasto incurrido por estos pacientes varía entre el 24,4 y 27,2%. Las proporciones históricas de acceso en instituciones privadas a esta cirugía son en el tramo A 7%, tramo B 13%, tramo C 24% y tramo D 52%. CONCLUSIÓN: El 50% de las cirugías de artroplastía de rodilla se realizan en instituciones públicas y dos tercios se realizan en pacientes del Fondo Nacional de Salud. El 46% de los tramos C y D se operaron en el sistema privado. La pandemia ha aumentado la brecha de acceso, lo que ha provocado un alza significativa en la proporción de pacientes del Fondo Nacional de Salud de los tramos B, C y D que han migrado al sistema privado para acceder a esta cirugía.

INTRODUCTION: Knee osteoarthritis affects the quality of life, with knee arthroplasty being a cost-effective treatment for the severe stage of this disease. Access to knee arthroplasty is a health indicator of the Organisation for Economic Co-operation and Development. The objectives of this study are to determine the incidence of knee arthroplasty between 2004 and 2021 in beneficiaries of the National Health Fund in Chile, the proportion of patients who underwent surgery in the private system, and to estimate the patient's out-of-pocket expenditure for surgery. METHODS: Cross-sectional study. We used the Department of Statistics and Health Information database. Patients discharged from a Chilean health center who underwent knee arthroplasty surgery between 2004 and 2021 were investigated. We analyzed the proportion of patients by their National Health Fund category and whether their surgery was performed in public or private network facilities. RESULTS: Of the 31 526 knee arthroplasty procedures, 21 248 (67.38%) were performed on National Health Fund patients and 16 238 in public institutions (51.49%). Patients from the National Health Fund showed a systematic increase in knee arthroplasty volume until 2019 but decreased in 2020 and 2021 by 68% and 51%. Of the total number of patients in the public system operated on for knee arthroplasty, 856 (9%) belonged to group A1, 12 806 (60%) to group B, 2044 (10%) to group C, and 4421 (21%) to group D. The expenditure incurred by these patients was estimated to vary between 24.4% and 27.2%. The historical proportions of access to this surgery in private institutions are 7% in group A, 13% in group B, 24% in group C, and 52% in group D. CONCLUSION: Fifty percent of knee arthroplasty surgeries are performed in public institutions, and two-thirds are performed on patients of the National Health Fund. Forty-six percent of the C and D groups were operated in the private system. The pandemic has increased the access gap, leading to a substantial increase in the proportion of patients from the National Health Fund of the B, C, and D groups who have migrated to the private system to access this surgery.

A unique binding pocket induced by a noncanonical SAH mimic to develop potent and selective PRMT inhibitors

Protein arginine methyltransferases (PRMTs) are attractive targets for developing therapeutic agents, but selective PRMT inhibitors targeting the cofactor SAM binding site are limited. Herein, we report the discovery of a noncanonical but less polar SAH surrogate YD1113 by replacing the benzyl guanidine of a pan-PRMT inhibitor with a benzyl urea, potently and selectively inhibiting PRMT3/4/5. Importantly, crystal structures reveal that the benzyl urea moiety of YD1113 induces a unique and novel hydrophobic binding pocket in PRMT3/4, providing a structural basis for the selectivity. In addition, YD1113 can be modified by introducing a substrate mimic to form a "T-shaped" bisubstrate analogue YD1290 to engage both the SAM and substrate binding pockets, exhibiting potent and selective inhibition to type I PRMTs (IC50 < 5 nmol/L). In summary, we demonstrated the promise of YD1113 as a general SAH mimic to build potent and selective PRMT inhibitors.

Clinical effect of a door shaped individualized dental archwire on the treatment of maxillary transposed canines / 口腔疾病防治

Objective @#To discuss the effectiveness and mechanism for movement of maxillary buccally transposed canines by using a door-shaped individualized dental archwire mechanic and to provide a reference for clinicians.@*Methods@#Eight patients with unilateral maxillary transposed canines were enrolled. All patients were treated with door-shaped individualized archwires. Before treatment (T1) and after the crowns of the transposed canines were moved to the right buccal positions in the dental arch during the treatment (T2), orthopantomograms were taken both at T1 and T2 to compare the linear changes (distance changes of the crown and root apex) and angular changes to study the mechanisms of tooth movement. The probing depth and buccal crown height were measured using a periodontal probe to compare periodontal changes before treatment (T1) and after treatment (T3) between the transposed canines and contralateral canines. @*Results@# All eight transposed canines were successfully brought back to their normal dental arch position but were made more buccal by using the door-shaped individualized dental archwire, with a mean of (11.5 ± 2.7) months. The average overall duration was (28.3 ± 4.7) months. The crown distance changes of the canines from T1 to T2 (8.1 mm) were greater than those of the root apexes (1.5 mm) (P<0.05). The mean angulation changes of the long axes of the canines were 17.5°. There was no significant difference in the depth of periodontal measurement and buccal crown height measurement between T1 and T3 (P>0.05). @*Conclusion @# The buccal movement of maxillary transposed canines under a door-shaped individualized dental archwire was effective and feasible. The movement pattern under this mechanism was controlled tipping.

Health insurance coverage and out-of pocket expenditure: A study among rural and urban households of Faridabad, Haryana

Introduction: Catastrophic health spending is one of the major factors pushing people into poverty. Reducing “out-of-pocket expenditure (OOPE)” on health through health insurance coverage is an effective approach. The objectives of this study are (1) to estimate health insurance coverage among rural and urban households (HHs) and (2) to determine the proportion of income spent on health as OOPE among the selected HHs. Material and Methods: A cross-sectional study was conducted in rural and urban parts of district Faridabad, Haryana. A sample of 374 were taken from rural and urban areas. The unit of the study was HHs in both the areas. The proportion of income spent on health care (both direct and indirect expenses included) as OOPE was taken as outcome variable. Results: Health insurance coverage was higher among urban HHs (58.0%) as compared to the rural (38.5%). The rural population was availing of private consultation, laboratory, and pharmacy services to a greater extent than the urban; hence, they were spending a substantial proportion of their income on health-care services. The majority of the HHs in the rural and urban areas spent up to 20% of their income on health care. Conclusion: Universal health coverage without health insurance is unlikely.

FETAL SONOGRAPHIC PARAMETERS BETWEEN GESTATIONAL DIABETIC AND NORMAL PREGNANT WOMEN.

Background– Gestational diabetes mellitus (GDM) is defined as intolerance of glucose seen during pregnancy and is associated with fetal and maternal morbidity. The aim of our study was to measure various fetal sonographic parameters such as fetal biometry, fetal liver length (FLL), amniotic fluid deepest pocket (AFDP), placental thickness, inter ventricular (IV) septum thickness, Wharton's jelly area and fetal abdominal fat thickness (FAFT) during 21-24 weeks of gestation and comparison of these parameters between Gestational diabetic and normal pregnant women. Tot Methods: al patients selected in our study were 100 in number, of which 50 had GDM and 50 were normal pregnant women. Fetal standard biometry with additional parameters were measured on transabdominal scan from 21-24 weeks. Fetal sonographic measurements and patients characteristics were measured and compared between two groups. P-value was evaluated along with mean, standard deviation, mean difference and confidence interval Patient characteristics and standard fetal Results: biometric parameters were comparable except for femur length (FL), mean femur length was significantly greater in GDM women compared to normal pregnant women (39.20 ± 0.70 vs. 38.36 ± 1.20, p = 0.001). Mean values in GDM vs. normal pregnent women were, fetal placental thickness in mm ( 42.28 ± 2.09 vs. 33.24 ± 1.70, p = 0.001), amniotic fluid maximum vertical pocket in mm (54.96 ± 1.24 vs. 44.46 ± 1.06, p = 0.001), fetal abdomen fat layer thickness in mm (3.59 ± 0.17 vs. 3.46 ± 0.15, p = 0.001), inter ventricular septum thickness in mm (3.71 ± 0.13 vs. 3.63 ± 0.16, p = 0.001), fetal liver length in mm (36.48± 1.15 vs. 31.86 ± 0.90, p = 0.001), Wharton jelly area in mm2 (115.26 ± 1.96 vs. 109.34 ± 4.81, p = 0.001), Fetal sonographic Conclusion: parameters are significantly increased in GDM women compared to normal pregnant women even before 24 weeks. Measurements of these parameters in routine practice could be used to monitor fetal growth and hence can prevent fatal complications.

A Retrospective Cohort study on Utilization of Rashtriya Bal Swasthya Karyakra (RBSK) Services among Children Screened at an Urban Health Centre (UHC) ofAhmedabad Municipal Corporation (AMC)

Introduction : Rashtriya Bal Swasthya Karyakram (RBSK) is a systemic approach of 4‘D’s (Defect, Diseases, Deficiency, Developmental delay) for early identification and linkage with care, support and treatment. (1) Document utilization of RBSK services within a year of referral, (2) Assess reasonsObjectives : for non-utilization of services and (3) Assess out of pocket expenditure (OOPE) among users and non-users of the program. Retrospective Cohort Study was conducted at an Urban Health Centre (UHC) takingMethod: two cohorts of children referred for 4‘D’s during April 2018-March 2020 under RBSK. A total of 102 cases were sampled. Probability Proportionate to size (PPS) method was used to ensure proportionate representation of each of 4‘D’s in the sample. Required number of participants in each category were selected randomly. Out of 102 sampled cases, 97 were covered. Utilization of services was 50.5%; majorResults: reasons for non-utilization were preference for private providers and reluctance to stay at Comprehensive Malnutrition Treatment Centre (CMTC). Mean OOPE in users was Rs. 21545, significantly less (p <.05) than Rs. 70198 in non-users. After referral by RBSK team, only half utilized the services. Among users,Conclusion: OOPE was less for total cost incurred and also for direct cost incurred like consultation charges, medicines, consumables etc. Counselling those parents whose children are detected with any of 4Ds, to visit Child Malnutrition Treatment Center (CMTC)/ District Early Intervention Center (DEIC) remains a challenge.

Determinants Of Maternal Mortality: An Empirical Study of Indian States Based on The Random Effect Model Analysis

Background: Healthcare for mothers and children is a significant indicator of a country's well-being. In-dia is one of the nations that were experiencing a rather slow improvement in maternal and child health. Aims: The objective of this study is to analyse the changes in health infrastructure, government health expenditure, antenatal care, postnatal care, institutional delivery, Maternal Mortality Ratio (MMR) and the determinants of MMR in India. Methodology: The study is based on secondary data. It employs an Average Increasing Rate (AIR) and Average Reduction Rate (ARR), as well as a panel data random effect model. Results: Empirical results say MMR has a statistically significant inverse relationship with female litera-cy, Per capita Net State Domestic Product (PNSDP), and institutional delivery. The study concludes that after the introduction of NRHM and its constituent elements like JSY and JSSK, government expenditure on health, health infrastructure, the percentage of antenatal care, post-natal care, and institutional deliv-ery increased in most of the Indian states, thus helping to increase the pace of the reduction of MMR. However, state performance varies greatly. Conclusions: Policy alone will not provide the desired results; it is also critical to focus on education, particularly female literacy, and economic empowerment.

Envisioning the Financial and Psychological Hardships of Cancer

Cancer is one of the leading causes of premature death and disability worldwide. With the progress of the health-care system, the cost of cancer treatment is also rising. Poor households suffer disproportionately from the financial burden of cancer treatment, which has pushed many households into poverty. Thus, cancer poses an economic burden for individuals, families, societies, and governments because of the prolonged medical costs, out-of-pocket expenditures, loss of productivity, and premature deaths. Moreover, the psychological breakdown phenomenon and social implications of cancer play a vital role in dealing with cancer patients. The psychological effect of battling with cancer falls not only on the patient but also on the caregivers and family members. With these backgrounds, an attempt is made in this review paper to highlight the implications of cancer on financial and psychological aspects.

Comparison of prices of commonly used drugs in AMRIT pharmacy, Jan Aushadhi Centre and Private chemist shop: An analytical study from a tertiary care centre in Haryana

Background: The price of medicine in India has always been a point of discussion in public domain. The price range of the same drug is very large with more than 100% difference between various brands available in different settings. Aims and Objectives: To assess the price of different drugs at Jan Aushasdhi (JA), AMRIT and Private Chemist and to compare the prices of these three outlets so that the issues. Material and Methods: This institution-based cross-sectional study was carried out from May 2019 to June 2019. A pretested proforma was prepared to compare the prices of 284 different medicines in Jan Aushadhi, AMRIT and private chemist shops. The collected data were entered in an Excel spreadsheet and presented in Proportions, percentages, and mean. Results: The price of 284 medicines were compared from JA (Median(IQR)- 15.18(18.75) INR) and Private chemist shop (Median(IQR)-88(111.5) INR) while 249 medicine from AMRIT (Median(IQR)-61.05(78.33) INR). Although the majority of the AMRIT drugs are cheaper than the chemist shop except for 31% of Antipsychotic drugs, 26.6% of antihypertensives, 25% of respiratory drugs, 25% of steroids, 21.9% of antibiotics. Conclusion: We concluded that JA is providing drugs cheaper than AMRIT and Private chemist . The prices of medicines offered at AMRIT are lower than market pricing but they are costlier when compared to JA prices.

Healthcare Financing in Saudi Arabia: Recent Trend and Future Challenges.

This paper provides an overview of the present healthcare financing system in the Kingdom of Saudi Arabia (KSA) and identify critical issues and challenges that need to be addressed in achieving healthcare system financing goals envisioned under the Saudi Vision-2030. This paper employed a descriptive framework based on literature review, documentation analysis, and secondary data on healthcare financing in the KSA collected from various reports. The study shows that the overall health expenditure as a percentage of Gross Domestic Product has increased from 4.4% (2001) to 6.4% (2018). The per capita expenditure on healthcare was US dollar (US$) 1484.6 in 2018, out of which the government's share was US$ 926.95. After the introduction of mandatory employer-based health insurance, the percentage of public funding on healthcare has slowly declined from 75.2% (2001) to 62.4% (2018), and out-of-pocket spending on healthcare reduced from 18.46% (2000) to 14.37% in 2018. The health financing system in the KSA faces several challenges, including health insurance coverage, access to care, equity, and quality of care.

Effectiveness of Health Education Package of Janani Shishu Suraksha Karyakram (JSSK) Scheme by Ante-Natal and PostNatal Mothers in a District Hospital of Faridabad (Haryana)

The Government of India had launched the Janani Shishu Suraksha Karyakram (JSSK) Scheme in June 2011 to benefi t pregnant women during their ante-natal, intra-natal and post-natal period including the new-born up to age of one year. In this quasi-experimental (pre-test, post-test, control group design) study, a total of 60 mothers (30 each in experimental and control group) attending ante-natal clinic at district hospital, Faridabad were enrolled using simple random sampling (lottery method). A self-developed, pre-tested and validated tool based on knowledge and utilisation about JSSK scheme was used for data collection. Mean post-test knowledge scores of experimental group and control group were 22.4 and 12 respectively with a mean difference of 10.4. The obtained mean difference was found to be statistically signifi cant as evident from the ' t' value of 3.96 at 0.05 level of signifi cance. The mean post-test utilisation score of experimental group (23.57) was higher than the mean post-test utilisation scores of control group (20.6) with a mean difference of 2.97. The obtained mean difference was found to be statistically signifi cant as evident from the ' t' value of 3.96 at 0.05 level of signifi cance. Chi value computed between knowledge scores and utilisation scores of JSSK Scheme and selected demographic variables indicated that there was no signifi cant association. This shows that health education package was effective in enhancing the knowledge of participant mothers regarding JSSK health scheme so that they were able to utilise the scheme in a better way. There is a need of IEC activity to increase the knowledge of benefi ciaries to enhance the utilisation of JSSK health services.

Análisis Microbiológico del Fluido Crevicular para Determinar Presencia de Candida albicans en Bolsas Periodontales de Sujetos Adultos

RESUMEN: El objetivo de este trabajo fue establecer la asociación entre la profundidad de bolsa periodontal y la presencia de Candida albicans en el fluido crevicular de sujetos adultos con salud gingival y periodontitis, recibidos en el área de la Maestría en Periodoncia de un Centro Odontológico. El estudio estuvo conformado por 81 muestras de fluido crevicular obtenidas con un cono de papel Nº 40. Fueron distribuidas en tres grupos: G1: 20 muestras del grupo control (salud gingival), G2: 32 muestras de bolsas con profundidad de 4-6 mm y G3: 29 muestras de bolsas con profundidad >6mm; que fueron colocadas en Caldo Sabouraud Dextrosa para su trasporte al laboratorio, donde fue cultivado en Agar Sabouraud Dextrosa por 48 h a 37 ºC. Posteriormente se realizó tinción a las colonias y prueba de tubo germinal para la confirmación de la presencia de Candida albicans. Del total de muestras, 12 (14,8 %) evidenciaron presencia de Candida albicans, de las cuales 6 (18,8 %) pertenecían al grupo de bolsas con profundidad de 4-6 mm y las otras 6 (20,7 %) pertenecían al grupo de bolsas con profundidad >6mm. En el grupo control, no se observó presencia de Candida albicans. Los pacientes con salud gingival no presentaron Candida albicans. Sin embargo, la Candida albicans estuvo presente en pacientes con bolsas periodontales de 4-6 mm y >6 mm (14,8 %). No se encontró diferencia estadísticamente significativa entre presencia de Candida albicans con profundidad de bolsa periodontal (p=0,849).

ABSTRACT: The aim of this work was to establish the association between the depth of the periodontal pocket and the presence of Candida albicans in the crevicular fluid of adult subjects with gingival health and periodontitis, received in the area of the Master in Periodontology of a Dental Center. The study consisted of 81 samples of crevicular fluid obtained with a No. 40 paper cone. They were distributed into three groups: G1: 20 samples from the control group (gingival health), G2: 32 samples from pockets with depth of 4-6 mm and G3: 29 samples from pockets with depth >6 mm; which were placed in Sabouraud Dextrose Broth for transport to the laboratory, where it was cultivated in Sabouraud Dextrose Agar for 48h at 37 ºC. Subsequently, colony staining and a germ tube test were performed to confirm the presence of Candida albicans. Of the total samples, 12 (14.8 %) showed the presence of Candida albicans, of which 6 (18.8 %) belonged to the group of pockets with depth of 4-6 mm and the other 6 (20.7 %) belonged to the group of bags with depth> 6mm. In the control group, no presence of Candida albicans was observed. The patients with gingival health did not present Candida albicans. However, Candida albicans was present in patients with periodontal pockets of 4-6 mm and >6 mm (14.8 %). No statistically significant difference was found between the presence of Candida albicans with depth of the periodontal pocket (p=0.849).