Factors affecting oral health-related quality of life among pregnant women

Abstract: Objectives: To assess oral health status and to describe the possible factors that could affect the oral health‐related quality of life (OHRQoL) among a group of pregnant rural women in South India. Materials and methods: A total of 259 pregnant women (mean age 26 ± 5.5 years) who participated in the cross‐sectional study were administered the Oral Health Impact Profile (OHIP‐14) questionnaire and were clinically examined for caries and periodontal status. Results: The highest oral impact on quality of life was reported for ‘painful mouth’ (mean: 1.7) and ‘difficulty in eating’ (mean: 1.1). On comparing the mean OHIP‐14 scores against the various self‐reported oral problems, it was seen that the mean OHIP‐14 scores were significantly higher among those who reported various oral problems than those who did not. Those with previous history of pregnancies had more severe levels of gingivitis than those who were pregnant for the first time. Also gingival index scores, community periodontal index of treatment needs scores and previous pregnancies was associated with poorer OHRQoL scores. Conclusion: Increased health promotion interventions and simple educational preventive programmes on oral self‐care and disease prevention during pregnancy can go a long way in improving oral health and lessening its impact on the quality of life in this important population.     

Management of resistant mucocutaneous herpes simplex infections in AIDS patients: a clinical and virological challenge

Background

The use of highly active antiretroviral therapy (HAART) has been associated with a marked decrease in the prevalence of opportunistic infections in HIV‐infected patients. However, chronic mucocutaneous herpes simplex virus (HSV) infection remains a difficult clinical challenge.

Objective

The aim of the study was to optimize the diagnosis and follow‐up of chronic HSV‐2 infection in HIV‐infected patients and to correlate clinical data with CD4 cell count, in vitro HSV virological resistance and histology.

Methods

A retrospective case series was collected from a specialist out‐patient clinic providing consultations to patients with infectious skin diseases. Clinical, biological, virological and histological data were analysed.

Results

Seven HIV‐infected patients with genital and perianal herpes simplex infection were followed over 10 years. Ulcerative and pseudo‐tumoral forms were observed. Lesions occurred at various stages of immune suppression (CD4 counts from 1 to 449 cells/μL). Clinical resistance to conventional anti‐herpetic drugs was correlated with the in vitro resistance of HSV in 70% of cases.

Conclusions

Chronic mucocutaneous HSV infection in AIDS patients remains a rare but regularly observed infection in very immunosuppressed patients or those with unstable immunity during HAART. Virological results obtained from mucocutaneous samples were in most cases found to be correlated with clinical evolution and should therefore be used in making decisions on treatment. Despite efficient antiviral therapy, mucocutaneous healing is slow in the majority of cases.     

Drug interaction leading to prolonged sedation in a postoperative high risk coronary bypass surgery patient

Use of midazolam infusion in mechanically ventilated patient is an established practice in critical care. In our case, the use of erythromycin as a prokinetic agent for better tolerance of enteral feeding and paralytic ileus led to an interaction between midazolam and erythromycin, which resulted in prolonged and deeply sedated patient. In a critically ill patient, there is always a possibility of multiple drug interactions. It is important to understand them and they should be considered before starting new medication.     

Analysis of intron 22 inversions of the factor VIII gene in severe hemophilia A: implications for genetic counseling

Intrachromosomal recombinations involving F8A, in intron 22 of the factor VIII gene, and one of two homologous regions 500 kb 5' of the factor VIII gene result in large inversions of DNA at the tip of the X chromosome. The gene is disrupted, causing severe hemophilia A. Two inversions are possible, distal and proximal, depending on which homologous region is involved in the recombination event. A simple Southern blotting technique was used to identify patients and carriers of these inversions. In a group of 85 severe hemophilia A patients, 47% had an inversion, of which 80% were of the distal type. There was no association with restriction fragment length polymorphism (RFLP) haplotypes. The technique has identified a definitive genetic marker in families previously uninformative on RFLP analysis and provided valuable information for genetic counselling information may now be provided for carriers without the need to study intervening family members and the diagnosis of severe hemophilia A made in families with only a nonspecific history of bleeding. Analysis of intron 22 inversion should now be the first-line test for carrier diagnosis and genetic counselling for severe hemophilia A and may be particularly useful when there is no affected male family member or when intervening family members are unavailable for testing.     

Natural history of hepatic fibrosis progression in chronic hepatitis C virus infection in India

Background and Aim:  The rate of fibrosis progression per year can predict the time for the development of cirrhosis in chronic hepatitis C (CHC). We assessed the rate of fibrosis progression and the predictors of disease severity in Indian CHC patients.
Methods:  Of the 355 treatment-naïve, histologically-proven CHC patients, the precise duration of infection (from the time of exposure to HCV until liver biopsy) could be determined in 213 patients (age = 41.6 ± 14.7 years, male : female = 139 : 74, genotype 3 = 75%). The rate of fibrosis progression per year was calculated. The correlation of the advanced degree of fibrosis and age, duration of infection, age at the onset of infection, sex, mode of infection, hepatitis C virus (HCV) genotype, histological activity index (HAI), and the presence of diabetes mellitus were studied.
Results:  The median rate of fibrosis progression per year was 0.25 (0.0–1.5) fibrosis units. The fibrosis progression rate was higher in patients who acquired infection at > 30 years of age, those < 30 years (0.33 vs 0.15; P  < 0.001), and those who acquired HCV infection with a history of blood transfusion than with other modes of transmission (0.25 vs 0.19; P  = 0.04). The median time to progress to cirrhosis was 16 years. The multivariate analysis found that the HAI score (odds ratio [OR]= 14.03; P  < 0.001) and the duration of infection > 10 years (OR = 4.83; P  < 0.001) correlated with severe liver disease (fibrosis ≥ 3).
Conclusion:  The median rate of fibrosis progression per year in Indian CHC patients is 0.25 fibrosis units. A higher HAI and longer duration of infection are associated with a significant risk of advanced liver disease, and merit early therapeutic interventions.