Editorial

Background: Congenital hearing loss is estimated to be 1–6/1000 live births. In India, it is reported to be 5.6/1000 live births. The Joint Committee on Infant Screening 2007 recommends that all newborns be screened for hearing loss by 1 month of age, have diagnostic follow-up by 3 months, and receive appropriate intervention by 6 months of age. Objective: This descriptive study was conducted to determine the age at diagnosis of hearing impairment in deaf children and determine the factors affecting it in South India. Materials and Methods: A cross-sectional questionnaire-based study was conductedon children with hearing impairment (bilateral profound hearing loss) attending 10special schools in Southern India.The cluster sampling technique was used to collect the data. Result: Our study involved 273 children in the age group of 3–22years.We found that the mean age at diagnosis of hearing impairment was 23.03(±3.696 SD) months while the mean age at suspicion of hearing impairment in these children was 13.70(±2.13 SD)months.The various factors responsible for the delay in diagnosis were financial constraints, influenced by friends and family, fear, and anxiety. The treatment-seeking behavior among the parents, lack of awareness of clear guidelines among the medical fraternity,and absence of awarenessof this problem among the general public also contributed to the delay

Introduction: The study was conducted to assess facial asymmetry in various dental malocclusions and to determine asymmetry in lower, mid, and upper face, and jaws using posteroanterior (PA) cephalometric analysis. Method:Atotal of 120 PAcephalograms were taken of individuals between 12 and 25 years age group of both sexes and were divided into fourgroups, Angle’s Class I excellent occlusion, Angle’s Class I malocclusion, Angle’s Class II malocclusion, and Angle’s Class III malocclusion. These cephalograms were traced, and Grummons analysis was performed. Results: In Angle’sClass I occlusion and Angle’sClass II malocclusion the results obtained showed asymmetry was present in the upper face. The correlation was found between occlusion, malocclusion, and facial asymmetry. Conclusion: Facial asymmetry was found in all dental occlusions whether excellent or malocclusion group, with maximum asymmetry having an upward trend toward upper face starting from lower

Introduction: “Healthy” state is one’s right to live creatively and productively. When sick, patients pay fixed and additional costs. Fixed costs are borne by Badan Penyelenggara Jaminan Sosial (BPJS/Indonesian Social Security Management System). Additional costs, however, becomes the patient’s expense. Purpose: Analyzing the ability and willingness to pay (WTP) additional costs during health services at Community Health Centers in Kupang District. Method: This was a survey research with cross-sectional approach. Independent variables: (1) Ability and (2) WTP. Dependent variable: Surcharges for health services. Sampling: A purposive sampling with 218 respondents. Variables measurement used a Likert scale. Result: Patients incur fixed costs as claimed costs to BPJS, additional costs (additional expenses, costs of meals for family members, transportation, and other expenses). The higher the respondent’s income, the higher the ability to pay additional costs (a = 0.009; t = 2.631). WTPadditional expenses is influenced by stage of illness suffered by the patient. The higher the stage, the higher the WTPadditional costs (a = 0.000; t = 14.906). Conclusion: High accumulation of additional costs becomes a burden for BPJS participants during health services at Community Health Center in Kupang district.

Introduction: Mechanical removal of plaqueby means of brushing and flossing is time-consuming and is also technique sensitive. Hence, effective plaque control of 100% may not be rendered always by these techniques. Adjuncts in the form of medication or mouthwashes are always recommended to assist tooth brushing in plaque control. The use of herbal mouthwashes has been a boon to control the oral health-related problems. Triphala is one of the best-known combinations used for various ailments in Ayurveda. The present study is thus aimed at comparing chlorhexidine and triphala,asan anti-plaque agent, and for treating gingivitis among adult patients. Materials and Methods:Atotal of 210 patients were randomly divided into three groups: Group 1: Chlorhexidine (0.2%) Group 2: Triphala (0.6%) Group 3: Control group with no mouthwash. The examinations were done at baseline, 7 days, and 15 days using the gingival index and plaque index.Chi-square test was used to compare the inter- and intra-group findings usingSPSS 20.0 (Chicago, U.S.A). Results:Even though a higher percentage of patients showed greater improvement with Group 2 intervention than Group 1, the difference was not found to be statistically significant after 7 days of observation. After 15 days, the Group 2 patients showed lesser plaque accumulation compared to Group 1, yet this difference was not found to be statistically significant. With respect to gingivitis, even though more patients were showed improvement with respect toGroup 2 than Group 1 after 7 days and 15 days of observation, the difference was not found to be significant. Overall, the intervention with triphala provided better results than with chlorhexidine, but this was not statistically significant. Conclusion: Triphala and chlorhexidine help as an adjunct to toothbrushing for the control of plaque and resultant gingivitis. Triphala can be used as a substitute to avoid the side effects of the long-term use of chlorhexidine

Arginase is a urea cycle enzyme which catalyzes the cleavage of L-arginine to L-ornithine,and urea. Arginase deficiency is inherited as an autosomal recessive genetic disorder. Hyperammonemia refers to a condition with elevated levels of ammonia in the blood, which is a product of protein degradation. The lack of the arginase enzyme results in excessive accumulation of nitrogen, in the form of ammonia (hyperammonemia) and arginine (hyperargininemia) in the blood. In the present study, the erythrocyte arginase activity is measured along with plasma ammonia concentration in the newborns and children. The study group consists of 133 subjects which are divided into two groups based on the ammonia level. Group 1 consists of subjects with normal ammonia (n=92) and Group 2 consists of subjects with high ammonia (n=41). We found a significant decrease in arginase activity in the high ammonia group compared to the normal ammonia group. A significant negative correlation between arginase and ammonia is observed in both the groups. The result of this study suggests that arginase deficiency could be the cause for hyperammonemia in these cases. Hence, we suggest that estimation of erythrocyte arginase activity can be used as a screening procedure to detect arginase deficiency in newborns, infants, and children with hyperammonemia.

Backgroundand Aims: Controlled hypotension has been used to reduce bleeding, the need for blood transfusions and provide a satisfactory bloodless surgical field. Esmolol, a short-acting cardioselective beta-blocker and dexmedetomidine, a central a-2 adrenergic agonist both cause controlled hypotension. The aim was to study the effect of dexmedetomidine and compare it to esmolol for controlled hypotension, surgical field, dose requirement of induction agent, requirement of inhalational agent, and muscle relaxant in middle ear surgeries. Method: This study is a prospective, open-labeled, and single-center study. 100 patients of American Society of Anesthesiologists physical Status I and IIscheduled for middle ear surgeries lasting for 2–3 hunder general anesthesiawere included. Patients were divided into two groups of 50 each by computer-generated random numbers.Group E (n=50) patients esmolol infusion and Group D patients received dexmedetomidine infusion. Results:The two groups were comparable in terms ofhemodynamic parameters and surgical field assessment. The thiopentone dose requirement was 494 ± 12.93 mginGroup E and 354.50 ± 17.26 mg in Group D (P-0.022). The mean isoflurane concentration used in GroupsE andD was 45.30 ± 5.85 mland 13.79 ± 4.51 ml, respectively (P-0.002).The requirement of vecuronium was 11.19 ± 0.71mg in Group E and 4.58 ± 0.46 mg in Group D (P-0.009). Conclusion: The drugs provide controlled hypotension, good surgical field and reduce pressor response equally. In addition, dexmedetomidine reduces the dose requirement of induction agent, inhalational agent, and skeletal muscle relaxant

Context: Ventilator-associated pneumonia is the second most common complication among all types of nosocomial infections. Mechanical ventilation predisposes to formation of a biofilm which worsens the prognosis because of increased multidrug resistant isolates implicated in formation of biofilm. Aim of the Study: The study was conducted to find out the relationship between duration of mechanical ventilation, biofilm formation, and antibiotic resistance among VAPpathogens. Study Design and Methods: A descriptive analytical study of 150 clinically suspected VAPpatients was done. Patients were divided into Group I and II based on intubation duration for 1–5 days and more than 6 days, respectively. Endotracheal aspirate was collected from clinically diagnosed cases and processed as per standard microbiological techniques. Bacterial counts = 106 CFU/ mLfor quantitative cultures were considered significant. Biofilm production was detected by tissue culture plate method. Multivariate analysis was done to find out the association of the various factors. Results: Klebsiella pneumoniae was the predominant bacteria isolated followed by Acinetobacterbaumannii. Among Gram negative bacteria 66.8% were ß-lactamase producers. In biofilm production by tissue culture method, Group I patients, 72.4% of the isolates showed either strong / moderate biofilm formation and in Group II patients, 92.3% of the isolates showed either strong / moderate biofilm formation. Multivariate analysis revealed that bacteria isolated from VAPoccurring after 5 days of mechanical ventilation among prior antibiotic-treated patients were resistant to all the antibiotics tested. Conclusion: Bacterial aetiology, prolonged intubation, biofilm formation, and drug resistance have ramification on outcome of VAP. Hence removal of ET tube in regular intervals should be considered with a proper choice of antimicrobial treatment or using ETtube coated with drugs/ biomaterials that discourage biofilm formation may be explored