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   Table of Contents - Current issue
Coverpage
July-December 2017
Volume 5 | Issue 2
Page Nos. 145-282

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EDITORIAL  

Preserving the passion and the attractions of clinical medicine: Shaping the medical students of the future Highly accessed article p. 145
Bhaskara P Shelley
DOI:10.4103/amhs.amhs_120_17  
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INVITED EDITORIAL Top

Trends and opportunities in medical education: Aligning to societal needs and expectations p. 154
Jerry M Maniate
DOI:10.4103/amhs.amhs_98_17  
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ORIGINAL ARTICLES Top

Role of different factors as preoperative predictors of conversion of laparoscopic cholecystectomy to open cholecystectomy p. 157
Ramlah Ghazanfar, Maham Tariq, Haider Ghazanfar, Sara Malik, Mehwish Changez, Jahangir Sarwar Khan
DOI:10.4103/amhs.amhs_58_17  
Aim: Laparoscopic cholecystectomy has become the gold standard for the treatment of gallstones. Background: The objective of our study was to identify the preoperative predictors of conversion of laparoscopic cholecystectomy into open cholecystectomy. Materials and Methods: We carried out a cross-sectional study in the Surgical Unit 1, Holy Family Hospital, Rawalpindi, from September 2016 to February 2017. All patients undergoing laparoscopic cholecystectomy were included in the study. Patients undergoing open cholecystectomy due to the presence of contraindication to laparoscopic cholecystectomy or patients in which laparoscopic cholecystectomy was a part of some other laparoscopic intervention were not included in the study. SPSS version 21 was used to analyze the data. Results: The overall mean age of the patients was 43.67 ± 13.54 years. The male patients were significantly older as compared to the female patients. The conversion rate was higher in patients who had an elevated total leukocyte count and alanine aminotransferase before the operation (P < 0.05). The rate of conversion was significantly higher in male patients aged ≥50 years (P < 0.05). Difficulty in the dissection of the triangle of Calot, difficulty in dissecting the gallbladder fossa, bleeding in gallbladder fossa, presence of duodenal fistula, and autolyzed gangrenous gallbladder were the reasons for the conversion to open cholecystectomy. Conclusion: The rate of conversion of laparoscopic cholecystectomy to open cholecystectomy was found to be 5%. Male patients aged ≥50 years, acalculous acute cholecystitis, acute cholecystitis, elevated preoperative total leukocyte count, and alanine aminotransferase levels were found to be significant predictors of conversion to open cholecystectomy.
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Knowledge and practices of oral health care in final year undergraduate nursing students: A cross-sectional study p. 161
Suryakant C Deogade, Vinay Suresan
DOI:10.4103/amhs.amhs_86_16  
Background: Nursing personnel plays a crucial role in promoting health and preventing information dissemination in the community. Aim: to assess and evaluate the oral health knowledge and practices of final year nursing students of Jabalpur, Madhya Pradesh (India). Materials and Methods: A cross-sectional survey was conducted in five nursing colleges of Jabalpur. A total of 172 students participated in the survey, which were given a questionnaire that comprised 26 questions. The questionnaire were evaluated under four parts such as information on dental and oral health, oral hygiene practices, attitude toward dentist and dentistry, and interest to improve knowledge, after which the data were analyzed to compare the statistical significance among the variables. Results: 84.3% of the participants knew how many teeth we have in our mouth. Many of them were not aware of proper brushing method. However, they revealed an adequate knowledge toward the identification of disease and its relation to general health. They also showed knowledge regarding the effect of diet on oral health, but 83.1% of them were confused with the identification of tooth decay. Approximately 51.7% of participants were unsure about the number of visits a person should make to a dentist. Conclusion: Nursing undergraduates have adequate knowledge on the basic oral structure and identifying oral diseases. However, they are little puzzled with the brushing method, number of visits a person should make to a dentist. They were not updated with the specialties in dentistry. Many of them showed interest toward camps and clinical postings to enhance their knowledge toward oral health care.
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Effect of atorvastatin on high sensitivity c-reactive protein, pulmonary function, and quality of life in chronic obstructive pulmonary disease - an open-labeled randomized control trial p. 167
Manisha Bisht, Jagdish Rawat
DOI:10.4103/amhs.amhs_124_16  
Objective: Beneficial effects of statins on chronic obstructive pulmonary disease (COPD) have been projected in many retrospective studies, but prospective studies were lacking. Hence, this study was done to study the efficacy of atorvastatin in improving the high-sensitivity C-reactive protein (hs-CRP levels), pulmonary functions, and quality of life in COPD patients. Materials and Methods: This was an open-labeled interventional study conducted on sixty stable COPD patients who were having abnormal lipid profile. The patients were randomized into two groups of thirty patients each – one receiving medications for COPD and another receiving 20 mg atorvastatin along with other medications for COPD. The outcome measures were change in hs-CRP levels, pulmonary function test, and health-related quality of life after 12 weeks. Results: A total of sixty participants with COPD were enrolled for the study and divided into two equal groups of thirty patients. There were two and one drop outs in atorvastatin and without atorvastatin group. After 12 weeks follow-up in the atorvastatin group, there was a significant improvement in the levels of hs-CRP levels from 4.82 ± 0.77 to 2.81 ± 0.73 (P < 0.05) as compared to other group without atorvastatin (4.34 ± 0.97–4.04 ± 0.63). Mean force expiratory value in 1 s as a percent of predicted value was similar in the atorvastatin and group without atorvastatin after 12 weeks: 54.2 ± 18.1–55.6 ± 17.9 (P = 0.54) and 55.7 ± 19.1–56.1 ± 18.1 (P = 0.58), respectively. Both treatments had similar improvement in St. George Respiratory Questionnaire total score. No adverse effect was observed in the atorvastatin group. Conclusion: Atorvastatin at a daily dose of 20 mg for 12 weeks has a significant beneficial effect on the levels of hs-CRP in COPD patient in comparison with the other group not receiving atorvastatin. There was no effect on the pulmonary function test and quality of life scores.
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Management of 159 cases of acute cancrum oris: Our experience at the noma children hospital, Sokoto p. 172
Adebayo Aremu Ibikunle, Semiyu Adetunji Adeniyi, Abdurrazaq Olanrewaju Taiwo, Ramat Oyebunmi Braimah, Olalekan Micah Gbotolorun, Olujide O Soyele, Mike Adeyemi, Abiodun Amoo, Rufai Jaffar, Moh'd Bashir
DOI:10.4103/amhs.amhs_23_17  
Background: Cancrum oris (Noma) is a rapidly progressive gangrenous infection of the oral cavity and its surrounding structures, which typically results in destruction of both soft and hard tissues. It requires urgent intervention, especially while still in the acute phase. We present an overview of our experience in the management of acute cancrum oris at the Noma children hospital, which is a regional referral center for such cases in Nigeria. Materials and Methods: This was a retrospective study of 159 patients managed for acute cancrum oris at the Noma children hospital, Sokoto, Nigeria. Early recognition of the disease, baseline investigations, identification of underlying disease/diseases, resuscitation of the patient, and institution of specific treatment were done. Results: The age range was 1–33 years with a mean (±standard deviation [SD]) of 3.5 (3.23) years. The male:female ratio was 1:1.2. Comorbidities were observed in 148 (93.1%) patients. The most commonly seen comorbidities observed were measles and protein–energy malnutrition, which were seen in 75 (47.2%) and 67 (42.1%) cases, respectively. The mean (±SD) hemoglobin of 8.59 (±2.9) g/dl and 11.38 (±1.5) g/dl were recorded on admission and at discharge, respectively. Leukocytosis of >12,000 cells/mm3 was observed in all patients. The electrolyte urea/creatine results were generally within normal range, while serum urea was raised in 52 (32.7%) patients. The duration of admission was for an average of 13 days. A mortality rate of 18.2% was observed. Conclusion: Acute cancrum oris requires urgent management. For successful management, patients should be evaluated for underlying diseases and systemic causes of immunosuppression.
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Evaluation of tobacco-associated oral lesions in the police personnel from Greater Mumbai: A survey with review of literature p. 177
Harsha Puri, Abhishek Singh Nayyar
DOI:10.4103/amhs.amhs_55_17  
Context: The police personnel resort to tobacco-associated habits often as a stress buster and consider the nicotine rush will settle their nerves so that they can focus better on their work. Recently, some nongovernmental organizations have taken a note of this and carried out health checkup camps for the police personnel in the city of Mumbai, but similar awareness for oral and dental health is still largely missing. Aim: The present study was carried out with the primary aim to determine the prevalence of tobacco-associated habits and oral lesions in the police personnel from Greater Mumbai. Materials and Methods: All the police personnel included in the study were subjected to a detailed case history elicitation and examination procedure after obtaining their informed written consent. Special stress was given in eliciting history of tobacco-associated habits while care was taken to diagnose tobacco-associated oral lesions such as tobacco pouch keratosis, preleukoplakia, leukoplakia, oral submucous fibrosis, carcinomatous, and other lesions. The data so collected were tabulated and sent for statistical analysis, and objective conclusions were drawn. Results: Use of tobacco with lime was found to be the most common habit present in the police personnel (34.0%), whereas the least common habit found was betel nut chewing (3.9%). In a sample size of 2388 police personnel included in the study, the overall prevalence of leukoplakia was found to be 11.12% with homogenous leukoplakia being the most common sub-type encountered (96.24%) with the second most common subtype encountered being speckled leukoplakia accounting for 2.26% of the cases reported. Conclusion: The results of the present study indicated tobacco-associated habits to be very common in the police personnel from Greater Mumbai which emphasized specific efforts to be made to reduce tobacco usage by police personnel on active duty.
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Perception of oral and maxillofacial surgery specialty among physicians in Sokoto, Northwest Nigeria p. 182
Ramat Oyebunmi Braimah, Abdurrazaq Olanrewaju Taiwo, Adebayo Aremu Ibikunle, Olalekan Micah Gbotolorun, Mike Adeyemi
DOI:10.4103/amhs.amhs_26_17  
Background: Oral and maxillofacial surgery (OMS) evolves from the anatomical region within the head and neck region. Contrary to common belief, its scope does not start and end with teeth. This study is to assess the awareness of physicians in Sokoto, Northwest Nigeria, about the scope of practice of OMS. Materials and Methods: This is a prospective cross-sectional study carried out during annual general meeting of the Nigerian Medical Association in Sokoto. This is the largest gathering of physicians in the state. Data were stored and analyzed using IBM SPSS Statistics for Windows version 20 (IBM Corp., Armonk, NY, USA) and results presented in simple descriptive statistics and frequencies only. Results: One hundred and twenty-five questionnaires of the 150 distributed were returned and analyzed with a response rate of 83.3%. The analysis showed that there is high awareness of the respondents about the scope of oral and maxillofacial surgeons (OMFS) in facial bone fracture, jaw deformities, orofacial tumors, and temporomandibular joint ankylosis (81.0%, 88.1%, 88.1%, and 82.5%) respectively. There is, however, low awareness about its scope in sinus problems, cleft lip and palate, and esthetic facial surgery (9.5%, 12.7%, and 14.3%) respectively. Conclusion: The awareness of the scope of OMS practices needs to be increased among physicians, especially in cleft lip and palate, sinus problems, and esthetic facial surgeries. It is imperative as OMFS specialty to raise awareness of our specialty among physicians.
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Workplace harassment among employees: An explorative study p. 187
Asha P Shetty, BV Nithyashree
DOI:10.4103/amhs.amhs_100_17  
Introduction: Workplace harassment is the belittling or threatening behavior directed at an individual worker or a group of workers. Matters of workplace harassment recently gained interest among practitioners and researchers as it is becoming one of the most sensitive areas of effective workplace management. Materials and Methods: Nonexperimental cross-sectional exploratory survey approach with quantitative design was adopted. Samples constituted both male and female employees 20–60 years working for minimum 6 h in an institution selected by random sampling technique. Data were collected using demographic tool and workplace harassment experience tool developed by the investigator. The Institutional Ethics Committee approval and the individual subject consent were also obtained. Results: Data obtained from 210 employees indicated that majority (20%) were between the age group of 30–35 years. Majority, 63.3%, of the employees had occasional harassment, 8.1% had mild harassment, 0.5% had severe harassment, and 28.1% reported no harassment at the workplace. Area-wise analysis indicated that highest possible area among participants was psychological (15.5 ± 7.26) and the lowest harassment was in the area of physical harassment (3.74 ± 1.75). Conclusion: Workplace harassment is a serious concern which requires immediate attention for better outcome. Although majority of the participants experience at least some form of harassment, they hesitate to objectively indicate the same due to fear of consequences of losing the job and facing further ramifications. The issue requires to be addressed with appropriate policies at the workplace. The study will help to plan the strategies to be implemented for building a healthy workplace environment.
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Comparison of two different forms of varnishes in the treatment of dentine hypersensitivity: A subject-blind clinical study in Lagos State university teaching hospital p. 191
Omotola Enere Owoturo, Adolphous Odogun Loto, Adenike Ololade Awotile, Afolabi Oyapero, Sylvanus O Ebigwei
DOI:10.4103/amhs.amhs_47_17  
Background: Dentine hypersensitivity is a significant clinical problem affecting several age groups within a population. Aim: This subject-blind randomized clinical study was designed to determine the clinical outcomes of two different varnishes in the management of dentine hypersensitivity. Materials and Methods: Self-reporting, consenting patients (n = 56) referred to the restorative unit of the dental center, Lagos State University Teaching Hospital (LASUTH), were examined for dentine hypersensitivity using the air jet and tactile probe methods. Enlisted patients were randomly assigned into Duraphat or Cervitec Plus varnish groups in a split-mouth study design. The teeth were assessed for sensitivity, and this procedure was repeated on week(s) 1, 2, and 4 following the initial visit. The data collected were analyzed using SPSS version 20, and statistical significance was done using the Student's t-test. P ≤ 0.05 was considered statistically significant. Results: The most affected teeth were the first molars (27.8%) followed by the second premolars (17.6%). There was a significant reduction in sensitivity following application of both control and experimental varnishes on day 1 and much further reduction by week 4. At week 4, P value using the tactile method was 0.090 while that of the air jet was 0.101. However, there was no statistically significant difference in the efficacy of the control and experimental varnishes. Conclusion: Duraphat exhibited better efficacy in the reduction of dentinal hypersensitivity, though the difference was not statistically significant. The Duraphat and Cervitec Plus varnishes can be substituted one for the other, though the Duraphat varnish is more readily available in our environment and costs less than Cervitec Plus varnish.
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Effect of vitamin E supplementation on superoxide and malondialdehyde generation in acute celphos poisoning p. 200
C Biwas, J Bala, Simmi Kharb
DOI:10.4103/amhs.amhs_39_17  
Introduction: Aluminum phosphide is one of the most commonly used grain fumigants and aluminum phosphide poisoning (ALP) has been reported as the most common cause of acute poisoning in India. Aluminum toxicity has been reported to increase the rate of lipid peroxidation and free radical formation. Materials and Methods: The present study was designed to investigate the role of vitamin E supplementation on free radical generation and lipid peroxidation in acute aluminium phosphide poisoning in rats. Thirty disease free albino rats were taken to study the effect of acute aluminium phosphide poisoning (ALP poisoning) were further divided into 3 subgroups of ten rats each: A, B and C. Group A: given vehicle (Ginni Oil) only. Group B: given 5 ml 'celphos mixture' (or 0.3mg/g body wt.). Group C: rats with acute Celphos poisoning along with vitamin E (1.5 mg vitamin E/g body weight of rat. The MDA levels and superoxide levels (Nitroblue tetrazolium (NBT) reduction) were estimated. Results: MDA levels were significantly higher in the group B as compared to Group A. In group C, administration of vitamin E resulted in decreased MDA level compared to group B. MDA levels in group C still remained significantly higher as compared to group A. NBT reduction was significantly increased in group B as compared to group A. Administration of vitamin E to rats of group C resulted in significant decrease of NBT reduction. Conclusion: Findings of the present study showed that vitamin E via its antioxidant action and anti-inflammatory effects has protective effect on phosphine-induced toxicity in rats.
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Goiter Survey among School Children (6–12 Years) in Northern Himalayan Region p. 204
S Muhammad Salim Khan, Inaamul Haq, Sheikh Mohd Saleem, Mehak Nelofar, Rachel Bashir
DOI:10.4103/amhs.amhs_83_17  
Background: Deficiency of iodine results in impairment of thyroid hormone synthesis and abnormalities grouped under the heading of “iodine deficiency disorders (IDDs).” Goiter surveys are conducted to estimate the region's iodine status. In view of this, we conducted this goiter survey among school-going children of district Baramulla, Kashmir division, to see the prevalence of IDD. Materials and Methods: This cross-sectional study was conducted among 6–12 years children in district Baramulla during the month of March and April 2017. The sample size of 2700 was calculated. The assessment of goiter was performed clinically by inspection and palpation of the thyroid gland. Results: In this study, we studied a total of 2700 school children in the age group of 6–12 years from district Baramulla with a mean age of 9 ± 1.86 years. 50.07% were boys. The age distribution prevalence of goiter among school children (6–12 years) in district Baramulla was observed to be 15.29%. The prevalence of Grade 1 goiter was more than twentyfold higher than Grade 2 goiter. The highest prevalence of Grade 1 and 2 goiter was seen among school children of 12 years age (25.19% and 1.81%, respectively). Females have higher prevalence of Grade 1 and Grade 2 goiter (17.58%). The relationship of goiter prevalence with gender and age was statistically significant. Conclusion: The present study showed mild goiter prevalence in school-aged children of 6–12 years in the district Baramulla of Kashmir valley. There is a dire need of periodic surveys to assess the magnitude of the IDD in the future.
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Impact of multimodal preoperative preparation program on children undergoing surgery p. 208
Priya Reshma Aranha, Larissa Martha Sams, Prakash Saldanha
DOI:10.4103/amhs.amhs_95_17  
Background: The advanced era of technological development in child health care has resulted in more pediatric procedures being performed in various settings. Millions of children undergo surgery every year which is a stressful event. Many nonpharmacological strategies are being used to manage the preoperative fear and anxiety in children. The current study aims to assess the effectiveness of multimodal preoperative preparation program (MPPP) on children undergoing surgery in terms of its effect on the psychophysiological parameters. Objective: The aim of this study is to assess the effectiveness of MPPP on the psychophysiological parameters of children undergoing surgery. Materials and Methods: A quasi-experimental study was conducted in a selected multi-specialty hospital. Using the purposive sampling technique, a total of 110 children aged 8–12 years were assigned to nonintervention (n = 55) and intervention (n = 55) groups, respectively. The MPPP was administered to the intervention group. The children in the nonintervention group received the routine preoperative care. Child's fear and anxiety was assessed on admission, prior to shifting the child to operation theater (OT), 24 and 48 h after surgery, whereas child's pulse, respiration, blood pressure (BP), and oxygen saturation was assessed on admission, prior to shifting the child to OT, 6, 12, 24, and 48 h after surgery and pain was assessed at 24 and 48 h after surgery. Results: The mean fear and anxiety scores of children were significantly lower in the intervention group than that of nonintervention group (P < 0.05). Among the physiological parameters, only pulse, respiration, and BP showed significant difference (P < 0.05) between the groups, whereas oxygen saturation and pain scores did not differ significantly (P > 0.05). This study also found that there is a significant association between the psychophysiological parameters of children with the selected demographic variables (P < 0.05). A positive correlation was found between the psychological and physiological parameters of children undergoing surgery. Conclusion: The MPPP is effective on psychophysiological parameters of children undergoing surgery in terms of decreasing the fear and anxiety, stabilizing the physiological parameters of children and can be used in preparing school-aged children for surgery and can be practiced in the clinical setup.
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Drug promotion in a resource-constrained Nigerian environment: A cross-sectional study of the influence of pharmaceutical sales representatives on the prescribing behaviors of medical practitioners in Abia State p. 215
Gabriel Uche Pascal Iloh, Miracle Erinma Chukwuonye
DOI:10.4103/amhs.amhs_73_17  
Background: Pharmaceutical drug promotion is an important component of pharmaceutical care and is one of the factors that may lead to unethical drug prescriptions. As the impetus for rational drug use grows, emphasis should also be focused on prescribing behaviors of physicians, particularly in resource-poor settings. Aim: The study was aimed at describing the influence of drug promotion by pharmaceutical sales representatives (PSRs) on the prescribing behaviors of medical practitioners in Abia State, Nigeria. Materials and Methods: A descriptive study was carried out on a cross-section of 185 medical practitioners in Abia State, Nigeria. Data collection was done using a pretested, self-administered questionnaire that elicits information on practice and attitude to drug promotion, types of incentives, frequency of visits, drug promotion methods and information, sources of drug information, and awareness of code of regulation on drug promotion. Results: The age of the participants ranged from 28 to 71 years. There were 166 males and 19 females. The prescribing practices of 47.6% of the medical practitioners were influenced by drug promotion and 66.5% of them had positive attitude to drug promotion. One hundred and sixty-four (88.6%) were visited >12 times in the previous year. The most common incentive received was branded stationeries (100.0%); predominant drug promotional method and information were in-person clinic encounter (100.0%) and brand names of the drugs (100.0%), respectively. The most common source of drug information was calling a colleague/pharmacist (93.5%) while 84.9% of the respondents were aware of code of regulation on drug promotion. The prescribing practice (P = 0.041) and attitude (P = 0.032) to drug promotion were significantly associated with working in public hospitals. Conclusion: Drug promotion by PSRs influenced prescribing practices of medical practitioners with 66.5% of them having positive attitude to drug promotion. The most common incentive, drug promotion method, and information were branded stationeries, in-person clinic encounter, and brand names of products/drug indications, respectively. The most common source of drug information was calling a colleague/pharmacist, and awareness of code of regulation of drug promotion was inadequate.
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Association of impaired sleep, impaired awakening, vitality, and fatigue related to dental caries p. 223
Shriya Jain, Komal Bhombe, Shravani Deolia, Shreya Patil, Bhavana Rajnalwar, Sourav Sen
DOI:10.4103/amhs.amhs_105_17  
Background: For humans, sleep is a vital indicator of overall health and well-being. It is a major public health problem. Insomnia has effect on oral health. Individuals with greater sleep disturbance or individuals getting less sleep are at higher risk of impaired oral health status and behavior. Aim: To evaluate association between sleep disturbance, vitality, fatigue, and oral health-related quality of life. Materials and Methods: A total of 150 nonmedical participants of age group 18 years and above were selected on the basis of individuals getting sleep ≤6 h. Data were collected using a self-administered questionnaire and standardized sleep disturbance scale (Karolinska Sleep Questionnaire), vitality scale (subjective vitality scale), and fatigue scale (fatigue assessment scale). The participants underwent an oral checkup wherein the decayed-missing-filled teeth (WHO modification) were recorded. The data were analyzed using STATA version 9.2 and ANOVA test was applied. Results: Individuals who perceived their oral health as poor/very poor reported with the highest score for impaired sleep (2.53 ± 1.02), awakening (2.50 ± 0.87), and vitality (3.12 ± 0.63) whereas the lowest score for fatigue (33.61 ± 8.47). Conclusion: An individual's lifestyle, health care habits, and behavior have an impact on overall well-being of the person.
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REVIEW ARTICLES Top

Vitamin D deficiency and cardiometabolic syndrome: Is the evidence solid? p. 229
Lubna A.G. Mahmood, Reem Al Saadi, Lorraine Matthews
DOI:10.4103/amhs.amhs_80_17  
Vitamin D is a fat-soluble vitamin which has an important role in bone metabolism with some anti-inflammatory and immune-modulating properties. It is very unique since it can be made in the skin from exposure to sunlight. Cardiometabolic syndrome (CMS) is a group of metabolic abnormalities that can increase the risk of cardiovascular disease and type 2 diabetes. It develops in an individual with any three of the following risk factors including obesity, diabetes, hypertension, dyslipidemia, and thrombosis. Both dietary and environmental factors, when combined with a sedentary lifestyle, lead to metabolic syndrome (MS) risk factors. The research outcomes propose to increase the current Vitamin D fortification level in foods to reduce the risk factors of the MS. Further researches are needed before clinical practice can recommend a Vitamin D prescription as a treatment for CMS in the general population.
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Prehospital care practices for venomous snakebites in resource-limited settings: A narrative review p. 237
Godpower Chinedu Michael, Ibrahim Aliyu, Bukar Alhaji Grema, Niongun Lawrence Paul De-Kaa
DOI:10.4103/amhs.amhs_93_17  
Venomous snakebite is a medical emergency encountered worldwide, especially in resource-limited communities. It usually leaves victims at the mercy of traditional care, whose effectiveness have come under scrutiny over time. Several of these traditional/ first aid practices have also been reported over time. Controversies over their efficacy often result in confusion among snakebite victims, their caregivers, and sometimes, among health-care providers. This narrative review describes reported prehospital interventions for venomous snakebites highlighting their usefulness, dangers, and/or limitations associated with their use and the currently widely recommended prehospital activities for venomous snakebite.
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CASE REPORTS Top

Visual rehabilitation with secondary intraocular lens implantation in a case of hallermann–streiff syndrome p. 242
S Rashmi, Praveen S Alavandi
DOI:10.4103/amhs.amhs_19_17  
Hallermann–Streiff syndrome (HSS) is a rare congenital disorder with multiple abnormalities mainly affecting face, skull, hair, eyes, and teeth. We report a case of an 18-year-old Indian girl with HSS having typical physical features and ophthalmological manifestations. She had been operated for bilateral congenital cataract in her infancy, and since then, she had been aphakic in both eyes. She had poor vision in the right eye and irreversible blindness in the left eye. She underwent scleral-fixated (glued) intraocular lens implantation in the right eye with good visual recovery.
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Oral lichen sclerosus in a breast cancer patient on anastrozole therapy: A case report with brief review of literature p. 245
Chaturbhuj Agrawal, KV Pradeep Babu, Prashanta K Dash, Rajeev Saini
DOI:10.4103/amhs.amhs_17_17  
Aromatase inhibitors are approved hormonal agents for the treatment of breast cancer since the past few decades. These agents are usually well tolerated except some common side effects seen in day-to-day practice such as arthralgia and mood changes. Some of the side effects of these agents are still very uncommon and must be considered in differential diagnosis while evaluating these patients on follow-up as this therapy is usually taken for prolonged time period and careful risk–benefit assessment must be done before considering discontinuation of therapy. In this conversation, we report the occurrence of lichen sclerosis of oral cavity in an elderly female suffering from breast cancer who developed it while being on anastrozole therapy.
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Van der woude syndrome: A report of four cases p. 248
Suchetana Goswami
DOI:10.4103/amhs.amhs_66_17  
Van der Woude Syndrome (VWS) is a rare autosomal dominant disorder with high penetrance and variable expressivity. The condition occurs in about 1:100,000–1:40,000 stillborn or live births and is characterized by lower lip pits, cleft lip, and/or cleft palate. Associated features of VWS include ankyloglossia, high arched palate, limb anomalies, congenital heart defects bifid uvula and syngnathia. We report four interesting cases of VWS with orofacial features. None of the four patients had any family history of lip pits, cleft lip, and/or cleft palate. The first patient with VWS showed a fusion of primary mandibular anterior teeth and the fourth patient demonstrated a supernumerary mandibular incisor. These features are very unusual in patients with VWS.
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Leiomyosarcoma with rhabdoid differentiation arising from leiomyoma: A rare entity p. 252
Pooja Chauhan, Kavita Mardi, Ganga Rawat, Nidhi Raina
DOI:10.4103/amhs.amhs_81_17  
Leiomyosarcoma (LMS) arising in a leiomyoma (LM) is a rare event. Still rare is rhabdomyoblastic differentiation in leiomyosacoma. We present such a case of LMS uterus with rhabdomyoblastic differentiation arising in an LM in a 60-year-old menopausal woman who presented with lower abdominal pain. An ultrasound scan was suggestive of uterine fibroid. Total abdominal hysterectomy was performed for presumed LM. Grossly, fibroid had variegated appearance along with focal areas having whorling pattern and histopathology showed leiomyosarcomatous change in a benign LM with rhabdomyoblastic differentiation. This is a rare complication of LM and precise diagnosis of LMS is essential since it has an aggressive behavior.
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Inflammatory carcinoma of breast: The chameleon p. 255
Indranil Chakrabarti, Amitabha Basu, Nilanjana Ghosh
DOI:10.4103/amhs.amhs_89_17  
Inflammatory breast carcinoma is an extremely rare, rapidly progressive breast carcinoma which is a great masquerader and often is mistaken as an inflammatory lesion. This leads to the delay in diagnosis. Here, we report such a case where the mistaken clinical diagnosis led to it being treated with antibiotics. However, fine-needle aspiration cytology of the case saved the day. Histopathological confirmation followed by multimodal therapy was rendered, and the patient responded well to the treatment. Thus, awareness and recognition of this rare entity, which mimics various inflammatory and nonmalignant causes, is of paramount importance for the doctors and patients alike.
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Fusion of a primary mandibular lateral incisor and canine: A rarity p. 258
Treville Pereira
DOI:10.4103/amhs.amhs_78_17  
Fusion is a developmental anomaly of dental hard tissues characterized by the union of two adjacent teeth. It may be complete with the formation of an abnormally large tooth or incomplete with the union of crowns or roots only. The exact cause is still unknown. This report describes a case of unilateral fusion of the primary lateral incisor and canine in a 6-year-old female patient who accompanied her parents for dental treatment and later had a checkup herself during one of the visits to the dental clinic. Medical history was noncontributory while there was no family history of dental anomalies. An intraoral examination revealed that mandibular right primary lateral incisor was fused to the primary canine. The permanent central incisors were erupting lingually. The intraoral periapical radiograph showed a bifid pulp chamber with a normal-sized root canal. Since the tooth was noncarious, a preventive approach with a periodic follow-up was planned.
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SPECIAL ARTICLE Top

B12 deficiency in India p. 261
PK Sasidharan
DOI:10.4103/amhs.amhs_121_17  
B12 deficiency is extremely common in India as is Vitamin D, folic acid, or iron deficiency, all because malnutrition is extremely common, even among the rich. The reasons for these are too many and are related to diet, lifestyle, and social and cultural issues. Any one of its varied manifestations can occur in isolation and can be coexisting with other comorbidities. In addition, the symptoms are modified also by the underlying disorder causing its deficiency. In spite of being a common disorder, its recognition is delayed or missed because the manifestations are diverse in nature, affecting all the organs and systems, and is often subclinical. To add to the confusion, laboratory estimations are notoriously unreliable even from the best of centers and doctors tend to rely on laboratory estimate of B12 levels. In this scenario, the doctors in India have to sharpen clinical skill to make a clinical judgment and initiate therapy and advocate a diet plan to give benefit to the patient. The ways and means of picking up those with clinical or subclinical B12 deficiency and the reasons and solutions to the problem are discussed in this article.
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Nail evaluation in internal diseases: An indispensable exercise p. 269
Vaishnavi Gopal, Manjunath M Shenoy
DOI:10.4103/amhs.amhs_124_17  
Nails are the structures without any vital functions, but their diagnostic significance cannot be undermined. Nail unit constitutes the nail plate, nail bed, and nail folds which exhibit signs of the nail unit and internal disorders. Most nail changes are nonspecific, but some of them have high diagnostic significance. Many such changes have been described since the historic times, and many have been discussed in the recent literature. Diseases of the nail units such as infections may also indicate the presence of immunosuppression or diabetes. Interpretation of the nail changes requires an amount of expertise which any physician can obtain by careful observation. This article emphasizes the important nail signs in internal disorders.
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MEDICAL HISTORY Top

History of Medical Imaging p. 275
Yousif Mohamed Y. Abdallah
DOI:10.4103/amhs.amhs_97_17  
Nowadays, millions of studies perform daily around the world. Medical imaging developed throughout for >100 years. It is used to visualize the different body structure and the functional activities. This information is useful in judgment and management of different pathological conditions. This study aimed to study the historical development of medical imaging modulates. The new technologies decrease the radiation dose to the least levels.
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TEACHING IMAGES Top

Ulcerated calcinosis cutis p. 279
Ganesh Singh Dharmshaktu, Tanuja Pangtey
DOI:10.4103/amhs.amhs_103_17  
Calcinosis cutis is an uncommon disorder resulting in the deposition of calcium salts underneath the skin and subcutaneous tissues. Asymptomatic, giant lesion is a rare finding and rarer if present bilaterally over iliac bones. Frictional ulceration may at times be presenting feature of a chronic lesion that requires excisional biopsy.
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LETTERS TO THE EDITOR Top

Ridge guard p. 281
Rajiv S Desai, Subraj J Shetty, Raghuram Ganesan, Manish Chauhan
DOI:10.4103/amhs.amhs_77_17  
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