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   Table of Contents - Current issue
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April-June 2022
Volume 14 | Issue 2
Page Nos. 59-123

Online since Tuesday, August 9, 2022

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SYSTEMATIC REVIEW ARTICLE  

India's COVID-19 vaccine implication on bangladeshi's health: A systematic research p. 59
Nancy Puri, CR Akhouri
DOI:10.4103/ajprhc.ajprhc_6_22  
Aim: The aim of this study is to curb the spread of COVID-19, India, has provided the Made-in-India AstraZeneca vaccine to Bangladesh. This research article will try to explain the AstraZeneca COVID-19 vaccine experience among Bangladeshi citizens. Methodology: The article is based on a qualitative research design and the authors have reviewed the related review of literature on the postvaccine experience and the efficacy of COVID-19 vaccines. Results: Through review-based literature, it was found that many Bangladeshi citizens including comorbid patients have not suffered any adverse events from the COVID-19 vaccines. Adverse events usually appeared after 12 h and went away within 48 h of vaccination. Most of the Bangladeshi population was satisfied during and after the vaccination program and most of them are recommending the COVID-19 vaccines to others as well. Conclusion: India constantly supplied COVID-19 vaccine assistance to Bangladesh and no adverse events from the vaccine were observed among the people.
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ORIGINAL ARTICLES Top

COVID-19 pandemic: Its effects on perception of learning among students of dental schools in Jeddah p. 64
Ullal Anand Nayak, Remaz Ahmed Mahmoud, Aman Yasser Azzawi, Walaa Essa Althagafi, Ahmed Mohammed Algarni, Prathibha Anand Nayak
DOI:10.4103/ajprhc.ajprhc_21_22  
Context: The COVID-19 epidemic having produced a sudden and dramatic change in teaching and learning approaches, it is imperative to ascertain the effectiveness of these frequently used methods. Aims: The present study intends to examine the learning experience of dentistry students during the COVID-19 epidemic and to determine the perception of these students regarding learning. Settings and Design: A cross-sectional survey was done among the students (3rd year through internship) from all the four dental schools in Jeddah using a nonprobability convenience sample approach. Subjects and Methods: A Google Form comprising the pilot tested survey questionnaire with open-ended 20 questions in English was distributed to the dental students by personal E-mails or social media/messaging. As per the response, the participants' descriptive statistics were reported in frequencies and percentages. Statistical Analysis Used: The Chi-square test was performed to seek for correlations between variables using the (IBM) SPSS software version 22.0. Results: A total of 415 dental students across four dental colleges of Jeddah participated in the survey. The most opted virtual platform for carrying out teaching was Zoom (64.58%). Nearly 67.71% of them showed good proficiency in using various electronic devices (P = 0.016). They preferred online video demonstrations of dental procedures over live demonstrations (P = 0.004). Students preferred to work in a simulation setting in a laboratory than working on patients with either nonaerosol producing procedures or with limited patient exposures (P = 0.012). They believed that their confidence level acquired in practical/clinical skills was good (P = 0.022), but the pandemic had negatively affected their personal well-being/career growth (P < 0.001). Furthermore, they agreed that the COVID-19 pandemic would change the future of dental education (P = 0.002). Conclusion: The COVID-19 pandemic has undoubtedly changed the way of education and virtual online education has becoming the new norm. The traditional assessment method of focusing solely on examinations needs to be updated.
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Knowledge, attitude, and practices about antimicrobial usage and resistance among the second-year MBBS students: A questionnaire-based survey p. 72
Sonali Pradeep Suryawanshi, Jayshree Shriram Dawane, Vijaya Anil Pandit, Pallawi Shashank Khatavkar
DOI:10.4103/ajprhc.ajprhc_10_22  
Antibiotic resistance is the burning issue and to curtail it is the need of the time, efforts are going on in all the direction. It is essential to assess the knowledge, attitude and practices of the medical undergraduate about the antimicrobial use and resistance for doing modifications in the current methods of teaching for encouraging the rational use. Objectives: To determine the prevalence of self medication practices of antibiotics among the second year medical students. To evaluate the knowledge of medical students about antibiotic resistance. To explore the solutions to curb the growing problem of antimicrobial resistance. Material and Methods: A Cross sectional, Unicentric, observational, questionnaire based survey study carried out from June 2021 to Sept 2021. Conventional sample method was used and phase II MBBS students willing to take part in the study were included. After obtaining the IEC clearance study was started. Questionnaire was prepared consisting of the various aspects like knowledge, attitude and perception of the antimicrobial use and resistance. The questionnaire was validated by subject experts for its content and relevance and the necessary changes were incorporated in the final one. The questionnaire was distributed as a Google form before they receive any teaching on antibiotics in their pharmacology classes as a Pre-test and after the exposure as post-test. Participation was voluntary and they were asked to complete the questionnaire anonymously. Returning of the completed Google form was accepted as consent by the participating students. Statistical analysis done with software SPSS. Results: Students had the knowledge about antibiotics and resistance. They had consumed it in last one year and completed the course of the antibiotics is the positive outcome. Small number shows confusion about use during viral infection, in pain, during cough& cold. Causes of antibiotic resistance needs special attention. In 20% it was not clear that skipping the doses can contribute to antimicrobial resistance. Conclusion: Repeated knowledge intervention are essential to increase the awareness of the problem arising due to the irrational use even to the undergraduate students.
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Quality and regulation standards for positron emission tomography equipment and bone marrow cell separator as medical devices in India p. 79
Nidhi Pandey, Gaurav Kumar Jain, Arti R Thakkar, Ramanpreet Walia
DOI:10.4103/ajprhc.ajprhc_11_21  
Introduction: Indian medical devices regulations have drastic changes since 2018. Few amendments have been incorporated in 2020. However, certain devices which are still not regulated and there are no quality checkpoints available for scrutiny from Central Drug Standard Control Organization, Delhi. This manuscript aims to provide quality checklist for two medical devices, positron emission tomography equipment, and bone marrow cell separator which are neither categorized nor regulated by the central drug standard control organization, Delhi. Methods: The quality checklist for the selected medical devices has been prepared by the survey based evaluation and quality tests have been identified by various methods available in the literature for checking risks associated with medical devices. Results and Discussion: Following quality checklist steps such as designing of primary checklist, quality assurance parameter evaluation for pet medication fabricating plant and equipment qualification criteria was identified with cross referencing and literature search. Conclusion: the new regulations would increase the accountability of the manufacturers and the importers to provide an assurance of safety to the customer. It needs to be incentivized by giving preference in public healthcare procurement instead of seeking USFDA and CE approvals. For the import of medical devices, the application should be reviewed based on risk analysis as suggested for these two devices. Further, local manufacturing of medical devices should be encouraged in India for reduced the cost of the medical devices.
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Post-COVID-19 infection: Mucormycosis – A tertiary care hospital experience p. 84
Harpal Singh, Kanwardeep Kaur, Sheenab Mittal, Ivanpreet Kaur, Manisha Mittal, Ramesh Kumar Kundal
DOI:10.4103/ajprhc.ajprhc_23_22  
Background: Mucormycosis is an opportunistic infection which has increased in the recent times of upsurge of cases of covid 19. Secondary infection by mucormycosis is noticed in individuals with low immune status, patients on steroid and oxygen therapy. Aims and Objectives:The aim was to analyse mucormycosis cases post covid19 as per age, gender, site of involvement, hospitalization status, site involvement and treatment outcome of patients. Materials and Methods: A retrospective study was conducted on specimens received in the Department of Pathology, over a period of 1 year in which 29 cases of mucormycosis were included. Specimens received in the laboratory were fixed in 10% formalin and submitted to detailed gross examination. Proper orientation in eye exenteration specimens and meticulous examination of the debridement specimens was done along with submission of representative sections in all the cases. Sections were then stained with H and E stain and special stain i.e., PAS and examined microscopically. Results: In this study, 29 patients over a period of 1 year are presented from a tertiary care center out of which 19 are males and 10 females, 82.75% patients with mucormycosis are covid 19 positive. Nasal cavity and maxillary sinus are most common sites involved. Survival rate in these patients is high due to early diagnosis and treatment. Conclusion: Hence, the present study emphasizes on the high incidence of mucormycosis in Covid 19 patients with predisposing factors mainly immunocompromised status, hospitalized patients. To prevent the occurrence of mucormycosis, early identification and further investigation of this fungus will significantly reduce the severity of the disease and mortality rate in Covid 19 affected patients.
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Decreased serum B12 due to antidiabetic drugs: Is it a potential contributor to inflammation in Type II diabetes mellitus p. 89
Divya Kanchi, Kannan Rajendran, Vinaya Vijayan, Malini Dutta, B Ramreddy
DOI:10.4103/ajprhc.ajprhc_30_22  
Background: The first-line medication, metformin, can decrease hepatic gluconeogenesis and improve insulin sensitivity. Metformin inhibits the mitochondrial respiratory chain at the molecular level, which leads to an increase in adenosine monophosphate-activated protein kinase, which enhances insulin sensitivity. With no known renal or hepatic disease, updated recommendations recommend using metformin as a first-line glucose-lowering medication in conjunction with lifestyle changes. Metformin has been demonstrated to lower vitamin B12 levels. Vitamin B12 is a vitamin that is necessary for proper hemopoietic, neurocognitive, and cardiovascular function. Vitamin B12 deficiency has been shown to be quite common in people with type 2 diabetes mellitus, both biochemically and clinically. Diabetes is thought to be an oxidative stress and chronic inflammatory disease. Vitamin B-12 is an antioxidant, as per recent research, and a low vitamin B-12 level might be a contributing factor to oxidative stress, particularly in diabetic patients. Vitamin B-12 is an antioxidant and anti-inflammatory substance that may influence oxidative stress responses, including inflammatory reactions. As a result, the goal of this research was to study at possible associations between vitamin B-12 status and inflammation in Type 2 diabetes mellitus who are on metformin and on metformin with other associated anti-diabetic drugs. Aims and Objectives: In our study we tried to see the association between serum B12 levels and proinflammatory cytokines which lead to many macrovascular complications like cardiovascular diseases, renal failure etc. Materials and Methods: The present study recruited 500 participants between 30 and 65 years of age. patient pool who has been recently diagnosed as type 2 diabetics on metformin usage for more than 12 to 18 months. The study design was divided into 3 groups: A, B, and C. Group A consisted of 200 subjects with type 2 diabetes only on metformin with a daily dosage of 500 mg/day, and Group B consisted of 200 subjects with type 2 diabetes who were on both metformin with a daily dosage of 500 mg/day and other anti-diabetic drugs of around 2 mg/day. Both groups A and B had no other complications from diabetes. Group C included controls, consisting of 100 healthy individuals with no history of diabetes. Results: The percentages of Serum B12, in both male and female groups were significantly decreased in cases and consequently, inflammatory markers like leptin, IL-6, hsCRP, TNF-α were significantly increased who were on metformin than who were on metformin and other associated drug group. Conclusions: Findings from this study clearly indicates the link between decrease in B12 and progression of inflammation. the role of metformin in vitB12 deficiency levels, uncontrolled glucose levels, and chronic inflammatory responses in T2DM patients, gradually leading to the dire consequences of B12 deficiency.
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Effect of dental fluorosis on oral health-related quality of life and daily performances among 12- and 15-year-old school-going children residing in high- and low-fluoridated areas of Meerut District p. 94
Shivangi Varshney, Ipseeta Menon, Ritu Gupta, Vikram Arora, Anubhav Sharma, Lavanya Rohatgi
DOI:10.4103/ajprhc.ajprhc_34_22  
Introduction: Dental fluorosis is a clinical situation that leads to changes in esthetic appearance in teeth. Oral health problems can cause problems in performing daily activities and social well-being, which may affect individual's quality of life (QOL). Aim: To assess the effect of dental fluorosis on oral health-related QOL and condition-specific oral impact on daily performance (CS-OIDP) among 12- and 15-year-old children residing in high and low fluoridated areas of Meerut district, UP. Methodology: A cross-sectional study was conducted among 200 12- and 15-year-old school-going children residing in high- and low--fluoridated areas of Meerut district. Dean's fluorosis index was used to evaluate dental fluorosis. A pretested questionnaire, CS-OIDP index, was used to assess the dental fluorosis effect on the oral health-related QOL and daily performances. Results: The mean CS-OIDP score among high-fluoridated area was 39.85 and a significant correlation was found between dental fluorosis, CS-OIDP, and oral health-related QOL (P < 0.005). Conclusion: The results of the present study can act as an alarm for dentists to carry out epidemiological investigation at village and district level to evaluate the risk factors and possible treatment and preventive measures.
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Spinal anesthesia for elective cesarean section – Comparison of levobupivacaine and ropivacaine with hyperbaric racemic bupivacaine p. 102
Melwin George, Shalini Miriam Ipe, Shaloo Ipe, Saramma P Abraham
DOI:10.4103/ajprhc.ajprhc_25_22  
Background: Spinal anesthesia is a popular technique for cesarean section, the commonly used drug being hyperbaric bupivacaine. Levobupivacaine and ropivacaine are newer local anesthetics in the Indian market with similar sensory block profile, lesser cardiotoxicity, but shorter duration of motor block. Aim: To determine the efficacy and safety of hypobaric levobupivacaine and ropivacaine and to compare it with hyperbaric bupivacaine all with fentanyl for spinal anesthesia in elective cesarean section. Study Design: This was a prospective, randomized controlled, double-blinded study. Methodology: Ninety pregnant patients were allocated to three groups of 30 each. Group A (control) received 0.5% hyperbaric bupivacaine 1.8 ml with 25 μg fentanyl, Group B (study) received 0.5% levobupivacaine 1.8 ml with 25 μg fentanyl, and Group C (study) received 0.75% ropivacaine 1.8 ml with 25 μg fentanyl. The efficacy and safety were assessed and analyzed using SPSS version 22. Results: Our study showed that ropivacaine is noninferior to hyperbaric bupivacaine, with a similar efficacy of 96.7%. Hyperbaric bupivacaine and ropivacaine are superior to levobupivacaine with a success rate of 96.7% versus 80%, with a P = 0.02 for superiority (one-sided). Duration of motor block was shorter in levobupivacaine (P < 0.001) and ropivacaine (P = 0.016) groups compared to bupivacaine group. Mean duration of analgesia was shorter in levobupivacaine (P = 0.001) and ropivacaine (P = 0.010) groups when compared to bupivacaine group. Although the percentage of patients having hypotension were similar among the groups, episodes of intraoperative hypotension and the amount of ephedrine consumed were higher in ropivacaine group compared to bupivacaine group (P = 0.039). Conclusion: Ropivacaine 0.75% appeared noninferior to hyperbaric bupivacaine 0.5% in terms of efficacy and safety. Levobupivacaine 0.5% was found to be inferior to bupivacaine and ropivacaine in terms of efficacy.
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Association of anxiety with oral health-related quality of life among Kashmiri Residents p. 110
Sana Bashir, Ipseeta Menon, Ritu Gupta, Anubhav Sharma, Vikram Arora, Lavanya Rohatgi
DOI:10.4103/ajprhc.ajprhc_35_22  
Introduction: Along with other healthcare indicators, psychological well-being of the population worldwide has been greatly affected after outbreak of covid-19. Almost all states in India including Jammu and Kashmir suffered during COVID-19. Thus this study was planned to determine the association of anxiety and its impact on oral health-related quality of life (14-item Oral Health Impact Profile [OHIP-14]) among residents of four districts of Jammu and Kashmir state during COVID-19. Materials and Methods: A self-administered questionnaire consisting of OHIP-14 along with a 7-item Generalized Anxiety Disorder Scale (GAD-7 Scale) was distributed among the residents of Kashmir via e-mails, WhatsApp groups, and Facebook using Google Forms. Results: Majority of the participants were males (53%) over 18 years of age. The most frequently experienced problems were discomfort during eating food (75%) and physical pain in the mouth such as aching in the mouth (60%). A highly statistically significant negative correlation was found between OHIP-14 and GAD among painful aching in the mouth (−0.044) (0.154**) **p<0.001. Half (50%) of the participants reported minimal anxiety. Conclusion: There is an unmet and immediate need to escalate the mental health services in Jammu and Kashmir state of India, which consisted of community participation, awareness programs, and mental health rehabilitation services.
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Challenges and acceptance of synchronized e-learning for undergraduates during COVID-19 pandemic: Teachers' views from a health school of India p. 117
Magna Manjareeka, Pratyush Kumar Kanungo, Soumya Mishra, Himel Mondal, Jayanti Mishra
DOI:10.4103/ajprhc.ajprhc_41_22  
Background: Synchronized e-learning has been the savior of the educational system during the current COVID-19 pandemic. As this is newly implemented in lockdown, adaptability by the teachers may face challenges. Objectives: We aimed to evaluate the perception and experiences of teachers on online live classes conducted during the pandemic in a health school in the eastern part of India. Materials and Methods: This cross-sectional online survey was conducted after getting the approval of the institutional ethics. The survey was conducted with medical, dental, and nursing teachers. The survey was anonymous. The self-administered questionnaire was distributed among teachers through Google Forms. Results: A total of 130 teachers participated in this survey with a response rate of 63.8%. Among them, 120 (90.2%) were first time taking online classes in their teaching career. Around 78% and 41.5% of the faculties experienced discontinuation of class due to Internet disruption and technical issues, respectively. Around 72.3% of faculties perceived that animations or videos may increase the attention of students. The majority of the teachers (86%) considered the traditional method to be better than online classes and it cannot be a substitute for classroom learning on normal curricular days. Conclusion: Due to sudden implementation and resource limitations, many teachers faced challenges in conducting synchronized e-classes. Teachers considered online classes to be learner-centric one with time and place flexibility. Although online classes are not a substitute for traditional classes can enhance each other in the post-pandemic period.
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