Table of Contents – July 2018

Background: Dental Medicine is a noble profession but the dentist-patient relationship has transformed over the last two decades by upsurge anxiety in the community and dental profession regarding increasing trends of complaints and lawsuits against dentists. Purpose: Knowledge about ethics and medicolegal issues is fundamental to the dental practice as clinical skills. This review was done to evaluate the oral healthcare services, and to provide awareness that a dentist should follow certain protocol to avoid any litigation in the name of malpractice. Materials and Methods: In January 2017 an electronic search was done of published literature in PubMed, Medline, EBSCO host and data base. The search was focused on literature on medicolegal issues and medical negligence. The titles and abstracts related to review and available in English were screened. Results: Due to the scarcity of articles on this topic, all the articles related to search were included in the study. Conclusion: Consent is a fundamental and established principle in the Indian Law. Professional indemnity insurance also known as ‘Defense Costs’ will pay all the costs, fees, and expenses incurred with their prior consent in the investigation, defense, or settlement of any claim made against the insured.

Cryptosporidium spp. are associated with diarrheal disease which leads to nutritional deficiencies and significant morbidity and mortality in children and patients with immune defects. The continuous emergence and molecular diversity of Cryptosporidium spp. still remains a threat to human health in respect of diarrhea and malnutrition in children <5 years. The impact of the cryptosporidiosis is exacerbated by the spread of human immunodeficiency virus/AIDS, and water shortage in most part of Southern Africa and the burden of the disease is underestimated within the region. Both anthroponotic and zoonotic transmission are identified as a common transmission route. Molecular characterization of Cryptosporidium infection is still a challenge, and there is a paucity of information on the burden of the parasite in Southern Africa. Ongoing attempts to find appropriate drugs and vaccines to cure and prevent the spread of the disease have limitations; perhaps considering isolation of bioactive compounds from medicinal plants extracts for their effectiveness and potency may be an option in future to control and eliminate the disease. This review considered the prevalence and molecular diversity in respect of transmission routes and associated risk factors. Urgent assessment of public health significance of this parasite in Southern Africa and elsewhere is of utmost importance. It is apparent that there is a need for adequate surveillance in monitoring the pathogen and to control the spread of infection.

Introduction: India is facing a challenge in controlling open-air defecation (OAD). There are various sociocultural and behavioral factors that influenced the practice. Objective: To study the attitude, behavior, and practice associated with OAD among individuals in Samayapuram area, Trichy district, Tamil Nadu. Methodology: This was a qualitative study done during August 2016. The topic guide comprised questions about OAD and latrines. Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted among various groups and individuals. Results: The study population comprised people of different age groups and gender residing in Samayapuram, Trichy District, Tamil Nadu. Five FGDs were conducted among field workers, adult males, adult females, and school children (both males and females). Ten IDIs were conducted among school children, adults, the elderly, a medical officer, an executive officer, a sanitary inspector, and a sanitary worker. The study showed that people prefer OAD over latrine for the following reasons: economical, habit, comfort, space constraints, opportunity to be combined with walking, smoking and chatting with friends, ventilation, and easy accessibility. They did not prefer community latrines for maintenance constraints such as water scarcity, cleanliness, and distance. Conclusion: The issue of OAD can be addressed only by strong and continuous motivation of individuals and groups. Any intervention to reduce OAD should aim at exploring the unique beliefs, culture, common factors, etc., for it to be effective. The intervention should be highly multidimensional with a special focus on behavior, engineering, and legislation.

Background: Although primarily a zoonotic disease, anthrax can be transmitted to human beings either directly or indirectly from animals. India being an endemic region for anthrax, the underreporting of cases from different parts makes it difficult to estimate the actual burden of anthrax, particularly in rural belt. Materials and Methods: A medical team consisting of members from medical college, public health and animal husbandry department went to visit a tribal village of Paschim Medinipur, West Bengal, from which place one person attended the skin department of Midnapur Medical College with painless hemorrhagic vesicular lesion. It resulted to high index of suspicion for an outbreak of anthrax. We interrogated the risk population of the area along with clinical examination and samples for relevant investigation were collected from them. Results: Out of 151 persons, 111 were found to come in contact with a dead cow. Among them, 11 persons had cutaneous anthrax, and all were associated with butchering animal. Attack rate was 7.3%, and the mean age was 35.9 years with a mean incubation period of 2.81 days. Six cows were found positive for anthrax in blood examination. Conclusion: Public awareness programs are to be undertaken from time to time so that early detection and treatment can prevent death from human anthrax. Regular survey and vaccination of livestock in endemic regions are to be undertaken by the animal health department.

Context: Disseminated tuberculosis (DTB) is quite an uncommon entity. It is usually undetected as it can present in an atypically bland manner and go unsuspected. Aims: Our study aimed to determine the frequency of DTB in autopsies in our setting. Subjects and Methods: A retrospective study was done for a period of 6 years, i.e., from January 2009 to December 2015, wherein all the cases of DTB encountered in autopsy specimens were included in the study. Results: During the study period, we encountered 19 cases of DTB. In all 19 cases, the organs examined were lung (19/19 cases), liver (18/19 cases), kidney (12/19 cases), spleen (18/19 cases), pancreas (3/19 cases), heart (8/19 cases), and brain (5/19 cases). Caseating epithelioid granulomas were seen in all cases of lungs (19/19 cases), 16 cases in liver, 12 cases in kidney, and 17 cases in spleen, 2 cases of heart, and 2 cases of pancreas. DTB accounted for 1.3% (n = 19) of all autopsy cases, with the mean age being 41.35 years. The male: female ratio was 18:1. Eleven out of 19 cases were unknown bodies. Acid-fast bacilli stain showed positivity in 10 cases. Conclusions: Despite recent technological advances in the diagnosis of tuberculosis, autopsy still remains an important complementary tool for identification of DTB.

Background: Sickle cell anemia (SCA) is a major global public health concern. Fetal hemoglobin level (HbF) is a major modulating factor of the clinical manifestation of the disease. In Nigeria, data on HbF level of children with SCA and its relationship with the spleen, a major reticuloendothelial organ, are scanty. Methods: In this cross-sectional comparative study, we determined steady-state HbF levels of children with SCA aged 1–15 years by high-performance liquid chromatography and compared with their age-, sex-, and socioeconomic class-matched HbAA controls. The spleen size was determined clinically and sonographically. Relationships between HbF level and spleen size and malaria parasite density were also determined. Results: About two-thirds of children with SCA had HbF level of <10%. However, they had significantly higher mean HbF level (9.6% ± 5.9%) compared with matched controls (0.5% ± 0.7%; P< 0.001). Higher proportion (9.8%) of children with SCA who were ≥8 years developed autosplenectomy compared to none of those <8 years (P = 0.012). There was no significant relationship between HbF levels and spleen size, although children with autosplenectomy had significantly lower mean HbF levels compared with those without autosplenectomy (3.5% ± 1.4% vs. 8.3% ± 3.5%, 95% confidence interval = 1.1–8.4, P = 0.012). HbF levels had no significant correlation with malaria parasite density, P > 0.05. Conclusion: Children with SCA had higher HbF levels compared with matched controls. Furthermore, patients with autosplenectomy had significantly lower HbF levels. Further studies exploring the roles of foetal haemoglobin on spleen functions in children with SCA are advocated, since spleen dysfunction is central to morbidity and mortality in this group of patients.

Background: Gestational diabetes mellitus (GDM) is a potential risk factor for pregnant women because it leads to various complications during pregnancy and childbirth; thus, GDM directly increases the risk of maternal and neonatal mortality and morbidity. Aim: To estimate the prevalence of GDM and evaluate maternal and fetal outcome in pregnant women with GDM. Materials and Methods: This was a prospective study carried out over a period of 1 year. After informed consent and ethical clearance, a total of 8970 pregnant women were recruited and followed; they underwent universal screening for diabetes as per the Diabetes in Pregnancy Study Group India criteria. Three-hundred and eighty women were diagnosed with diabetes, of this 29 were found to be type 2 diabetes and 351 pregnant women were diagnosed as gestational diabetes. Women with gestational diabetes were followed till 6 weeks of postpartum. After enrollment, 290 women were treated with regular insulin and neutral protamine Hagedorn insulin and only 61 women were kept on medical nutrition therapy. Results: About 76.1% of women underwent cesarean section, whereas 23.9% women delivered vaginally. Elective (LSCS) Lower segment caesarean section was done in 22% of women while emergency cesarean section in 54.1%. Preeclampsia was observed in 13.7%, 45.3% women delivered preterm baby, polyhydramnios was found in 3.41%, and oligohydramnios was found in 2% women. Candida vaginal infection was observed in 2.50% and intrauterine growth restriction present in 11.90% women. 8.3% babies were macrosomic and 3.1% babies were admitted in Neonatal intensive care unit. Stillbirth was noted in 4.3%. Congenital malformation was seen in 1.7% babies of GDM mothers who did not receive any antenatal care. About 26.5% of total GDM cases were unbooked. Conclusion: Gestational diabetes is a rising complication of pregnancy. If women receive proper medical nutritional therapy and insulin therapy during pregnancy, better maternal and fetal outcome could be achieved.