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  Citation statistics : Table of Contents
   2015| January-June  | Volume 3 | Issue 1  
    Online since April 13, 2015

 
 
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ORIGINAL ARTICLES
Risk factors associated with stillbirths in the rural area of Western Maharashtra, India
Shubhada Sunil Avachat, Deepak B Phalke, Vaishali D Phalke
January-June 2015, 3(1):56-59
DOI:10.4103/2321-4848.154946  
Background: Overall perinatal mortality rates have fallen considerably in the past several decades but fetal deaths have not decreased as rapidly as the neonatal portion. In 2009, two-third of the stillbirths in the world occurred in South Asia and sub-Saharan Africa and 55% stillbirths occurred in rural families from these regions. Knowledge of the relative importance of the different causes of stillbirth and neonatal deaths in developing countries is still lacking. Objective: A retrospective to assess the extent of stillbirths in a teaching hospital located in rural area. To study various causative and contributing factors for stillbirths. Materials and Methods: All the case records of the deliveries occurred in the study setting during study period (April 2009 to March 2010) were evaluated with the help of a predesigned proforma. Total 3,458 deliveries occurred, of them 141 were stillbirths. Results: Total 75.6% stillbirths occurred to the women in the age group of 20-35 years. Most of the stillbirths were preterm (67.3%) as compared to term or post-date deliveries. Significant association was observed between gestational age and stillbirth. Total 82 (58.15%) babies had low birth weight. Maternal factors were responsible for majority of stillbirths (53.19%) while 34% stillbirths were idiopathic. Conclusion: More than half of the stillbirths were associated with maternal factors like pregnancy-induced hypertension, antepartum hemorrhage and anemia. Improvement in availing essential obstetric care can reduce the magnitude of stillbirths.
  3 3,011 352
CASE REPORTS
A rare case of ceftriaxone induced anaphylaxis in anaethesia practice
Anita Kumari, Ruchi Gupta, Sukhminder Jit Singh Bajwa, Jagdeep
January-June 2015, 3(1):106-109
DOI:10.4103/2321-4848.154958  
Medications are among the second most common cause of anaphylaxis and the primary cause of anaphylaxis in adults. The most common classes of drugs causing anaphylaxis are antibiotics especially β-lactam antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). Diagnosis of anaphylaxis is clinically based and usually straight forward. However data on epidemiology of anaphylaxis, particularly the most profound and life threatening form such as anaphylactic shock is limited and thought to be under-reported. In spite of negative skin testing, our patient had severe reaction resulting in anaphylactic shock after antibiotic administration but was managed successfully without any residual compromise. This case reflects the limitations of screening test done preoperatively for the diagnosis of sensitization to the drugs.
  1 7,118 410
ORIGINAL ARTICLES
Evaluation of analgesic, anti-inflammatory, antipyretic and antiulcer effect of aqueous and methanol extracts of leaves of Polygonum minus Huds. (Polygonaceae) in rodents
Parayil Varghese Christapher, Teoh Yu Xin, Choong Fui Kiun, Lim Chong Leng, Ng Gao Fu, Gai Li Yuan, Subramani Parasuraman, Murugaiyah Vikneswaran
January-June 2015, 3(1):12-17
DOI:10.4103/2321-4848.154919  
Background: Polygonum minus (Kesum) is an annual plant that grows throughout South East Asian countries. The Leaf of P. minus is commonly used as diet ingredient in Malaysia. Traditionally the decoction of leaves of this plant is used to treat stomach ache and digestive problems. The plant has known antioxidant activity, and its pharmacological properties are remaining unclear. Hence the study is planned to evaluate the analgesic, anti-inflammatory, antiulcer and antipyretic activity of kesum. Materials and methods: P. minus leaves was extracted with methanol and distilled water by simple maceration. The dried extract was used for further phytochemical and pharmacological analysis. The analgesic effect of methanol and aqueous extract of P. minus was studied using acetic acid, tail immersion and formalin induced pain in rats. The anti-inflammatory effect of both extracts was studied using carrageenan induced paw edema in rats. The pyloric ligation model was used to study the antiulcer effect. The antipyretic effect was studied using Brewer's yeast induced pyrexia. Results: The percentage yield of aqueous and methanol extract of P. minus leaves were 1.15 and 2.57% w/w respectively. Both the extract showed significant analgesic effect against acetic acid writing, tail immersion and formalin induced pain methods, but the effect was not equivalent to that of standard. Aqueous extract showed significant anti-inflammatory action and methanol extract showed significant anti-ulcer effect. Conclusion: The aqueous extract of the P. minus has significant analgesic and anti-inflammatory action, whereas methanolic extract showed presence of analgesic and anti-ulcer activity. Both aqueous and methanolic extract did not show any significant antipyretic activity.
  1 3,220 412
Prevalence of diabetes and hypertension among a tribal population in Tamil Nadu
Shankar Radhakrishnan, Manivanan Ekambaram
January-June 2015, 3(1):66-71
DOI:10.4103/2321-4848.154948  
Background: Diabetes and hypertension is affecting at an alarming rate in both rural and urban populations in India and very few studies had been carried out among the tribal population. Objective: To determine the prevalence rate of type 2 diabetes mellitus and hypertension and its associated risk factors among the tribal population in Salem District in Tamil Nadu. Materials and Methods: A total of about 525 tribal population above 40 years of age from various tribal places in Yercaud. All of them were screened for diabetes, by checking the random blood glucose levels and blood pressure, body mass index, dietary patterns, and physical activity levels were also recorded. Their knowledge about diabetes was also assessed by a set of 10 questions. Results: Among the study population, people who had RBS ΃ 200 was 28 (male = 11 and female = 17) and between 140 and 200 were 39 (male = 18 and female = 21) and people whose were in the prehypertensive stage was 185 (males 92 and female 93) and people in the stage 1 hypertension was 102 (male = 47 and female = 54) and in stage 2 hypertension was 64 (male = 33 and female = 29). The co-morbidity (diabetes and hypertension) was present in among 45 (male = 25 and female = 20). Among the study population only 1 was obese and 39 were overweight. Among the various risk factors smoking, alcohol and positive family history were found to have a statistical significant association for males whereas among females only the family history was found to have a statistically significant association for both diabetes and hypertension. The knowledge of diabetes among the study population was very poor. None of them were aware about the normal levels of blood sugar and the risk factors. Conclusion: The study documented that the prevalence of diabetes and hypertension is increasingly high in the tribal areas and their awareness levels were very poor.
  1 7,582 426
Cutaneous basal cell carcinoma: A morphological spectrum
Prema Saldanha, PR Shanthala, Krishnaraj Upadhaya
January-June 2015, 3(1):24-28
DOI:10.4103/2321-4848.154935  
Background: Basal cell carcinomas (BCCs) are much less common than squamous cell carcinomas (SCCs) among the cutaneous malignancies in India. Most of the BCCs behave indolently with low metastatic potential. Histological diagnosis and classification of BCCs are essential to predict their behavior and course. This study was done to analyze the histological spectrum. Materials and Methods: A retrospective study was done with 25 cases diagnosed over a 5-year period. The relevant clinical details were obtained and the slides were reviewed. Results: Twenty-five cases of cutaneous BCC were analyzed. The age of the patients ranged from 50 to 95 years with equal incidence in males and females. The duration of the lesions varied from 2 months to 10 years. Most of the lesions occurred on the face with 12 cases in the periorbital region and 9 cases on the cheek. There were one case each with a lesion on the scalp, back, chest, and abdominal wall. The histological subtypes found in our study included nodular type (undifferentiated -14 cases, and with differentiation -7 cases), nodulocystic type -1 case and basosquamous (metatypical) type -3 cases. Conclusion: It is important to differentiate basal cell carcinoma from other skin tumors and also type the tumors as the prognosis and risk of recurrence depends on the subtype.
  1 5,662 477
Association between glycosylated hemoglobin and acute coronary syndrome in type 2 diabetes mellitus
Raju Hosuru Narayana, Nithyananda Chowta Kallige, Mangalore Venkatraya Prabhu, Mukta Nithyananda Chowta, Bhaskaran Unnikrishnan
January-June 2015, 3(1):29-33
DOI:10.4103/2321-4848.154938  
Background and objective: Chronic hyperglycemia in type 2 diabetes increases the risk of microvascular events. However, the prognostic value of hemoglobin A1c (HbA1c) level in patients with coronary atherosclerotic disease has not been well characterized and remains controversial. This study was an attempt to know the association between HbA1c and acute coronary syndrome (ACS) in Indian type 2 diabetic patients. Materials and Methods: This study is a case-control study done at a tertiary care hospital. Cases were diabetic patients with ACS and controls were diabetic patients without any evidence of ACS. To eliminate confounding bias, matching was done between two groups for age, sex, duration of diabetes, presence of hypertension, smoking, and dyslipidemia. Patients belonging to either gender in age group of 40-80 years, with diagnosis of diabetes mellitus (as per American diabetic association (ADA) criteria) on treatment were selected. HbA1c was measured by immunological assay. Results: A total of 60 cases (Group A, diabetic patients with ACS) and 60 controls (Group B, diabetic patients without the evidence of ACS) were included in the study. Mean age of patients in group A is 64.22 ± 6.39 years and in group B is 64.48 ± 6.57 years. Duration of diabetes group in A is 9 ± 5.75 years and in group B is 9.2 ± 5.45 years. The association of HbA1c level with ACS was highly significant when analyzed by multiple regression analysis after adjusting for confounders (adjusted odds ratio (OR): 4.92, confidence interval (CI): 2.16-11.17, P = 0.0001).The difference in HbA1c level between the groups was highly significant in the whole groups (P < 0.0001) and when analyzed by categorizing the patients based on gender, presence of hypertension, dyslipidemia, and smoking. Conclusion: HbA1c level is strongly associated with risk of ACS. Occurrence of ACS was significantly more in patients with HbA1c level more than 7% when compared with patients with HbA1c level less than 7%.
  1 2,717 308
Urinary tract infection, its causative microorganism and antibiotic susceptibility in Nagaland
Sedevi Angami, Nungsangmeren Jamir, Pratap Chandra Sarma, Akshay Chandra Deka
January-June 2015, 3(1):40-43
DOI:10.4103/2321-4848.154943  
Aim: We studied the causative microorganisms and antibiotic susceptibility of urinary tract infections (UTI) for both male and female in Nagaland, North-Eastern India. Materials and Methods: This is a retrospective study done at Christian Institute of Health Sciences and Research, Dimapur, where urinary samples received for culture and sensitivity in the laboratory from January 2012 to June 2013 were included. Organisms were identified by doing standard culture method, and antibiotic sensitivity was done by Kirby-Bauer Disc diffusion method from mid-stream clean catch urine sample. Results: A total of 1789 samples were analyzed in this study, where 502 (28.1%) showed significant growth, 330 (18.4%) showed insignificant growth, and the rest 957 (53.5%) showed no growth. The most commonly isolated bacterium was Escherichia coli both in an outpatient department (31%) and in-patient department (38%) patients followed by Klebsiella pneumonia, Pseudomonas sp., Enterococcus, Staphylococcus aureus, Candida, and Proteus. Analysis of the samples showed that UTI was more common in females (60%) as compared to males (40%). It was also observed that the samples responded effectively to chloramphenicol (29%), gentamicin (28%), imipenem (26%), and amikacin (21%). High degree of resistance was shown for nalidixic acid, ciprofloxacin, norfloxacin, amoxyclav, and ofloxacin. Conclusion: Antibiotics have been in use for a long period and more often the misuse of antimicrobial drugs has today led to a general rise in the emergence of resistant bacteria. This study may aid health professionals in choosing the appropriate treatment for patients in North-Eastern India.
  1 6,099 345
Prevalence of the metabolic syndrome among North Indian adolescents using Adult Treatment Panel III and pediatric International Diabetic Federation definitions
Riyaz Ahmad Bhat, Irshad Paray, Showkat Zargar, Ashraf Ganie, Imran Khan
January-June 2015, 3(1):44-49
DOI:10.4103/2321-4848.154944  
Background and Objective: Childhood obesity is an important risk factor for the development of metabolic syndrome (MS) in children and adolescent. Because of high prevalence of insulin resistance and MS in Indian adult population, studies are needed to identify the prevalence of these metabolic abnormalities in the adolescent population. The objective of this study was to estimate the prevalence of MS using pediatric International Diabetic Federation (IDF) definition and compare it with estimates of Adult Treatment Panel III (ATP III) definition among adolescents in Northern India. Materials and Methods: At a total of 899 adolescents attending school (aged 10-18 years) participated in this population-based prospective study. All the clinical and biochemical assessment were done after proper consent. The MS was determined by the National Cholesterol Education Program ATP III definition modified for age and pediatric IDF definition. Results: The prevalence of MS was 3.5% according to ATP III criteria and 1.5% based on IDF criteria. No significant gender difference was observed in the distribution of MS. Hypertriglyceridemia was the most common and abdominal obesity the least common constituent of MS. Conclusion: This study provides the first estimates of MS using pediatric IDF definition in the adolescent population from Northern India.
  1 2,697 223
SPECIAL ARTICLES
Dental implants: A boon to dentistry
BH Sripathi Rao, S Vidya Bhat
January-June 2015, 3(1):131-137
DOI:10.4103/2321-4848.154965  
The development and use of implants is one of the biggest advances in dentistry in the last few decades. It has helped to give many solutions to tooth loss as well as maxillo facial prosthetics. This article traces the history and evolution of dental implants.
  1 3,210 350
Dental ergonomics: Basic steps to enhance work efficiency
Abdul Rahim Shaik
January-June 2015, 3(1):138-144
DOI:10.4103/2321-4848.154966  
The nature of the dental profession and the postures assumed by the dental surgeons during their professional work has a huge impact on the dental surgeon's body and carries with it a high risk of musculoskeletal disorders (MSDs). To perform efficiently and effectively, they shall always like to attain a position that allows them to achieve optimum access, visibility, comfort, and control at all times. Good ergonomic design of the workplace is a basic requirement for facilitating the balanced musculoskeletal health that will enable longer, healthier career, enhance productivity, and minimize MSDs among dental surgeons. While treating the patients, they are concerned about patients' comfort and pay little attention to their own health till they begin to experience discomfort in their body. With a little attention and creativity, dental surgeons can improve their comfort on the job during the course of their career.
  1 9,677 1,091
CASE REPORTS
Saree cancer: A diagnosis!
Dakshayani S Nirhale, Mohit Bhatia, Virendra S Athavale, Murtuza Calcuttawala
January-June 2015, 3(1):121-123
DOI:10.4103/2321-4848.154962  
Saree cancer is a type of skin cancer that occurs along the waistline of Indian women wearing the traditional costume of 'saree'. The incidence of malignancy in scar tissues is 0.1-2.5%. Highly hypopigmented and thickened scars are more likely to progress into malignant lesions. Khanolkar and Suryabai described a new type of skin cancer - 'dhoti cancer' in 1945. Persistent and long term use results in chronic friction/irritation in the region of waist which in term leads to waist-dermatosis.
  - 2,269 147
Primary oro-pharyngeal tuberculosis mimicking as malignancy
Nizara Baishya, Ashok Kumar Das, Jagannath Dev Sharma, Abhishek Singh, Manigreeva Krishnatreya, Amal Chandra Kataki
January-June 2015, 3(1):124-126
DOI:10.4103/2321-4848.154963  
Primary oropharyngeal tuberculosis is a rare entity and accounts for 0.05-5% of all cases of tuberculosis cases. We report here a case of 20-year-old female with primary oropharyngeal tuberculosis. The patient initially presented with an ulcer-proliferative growth on the right tonsil. Subsequently, after a delay of 6 months due to noncompliance of the advice given, she presented with extensive involvement of the oropharynx. The diagnosis of primary tuberculosis was made after histopathological examination and cytological examination for exclusion of acid-fast bacilli in the sputum and bronchoalveolar lavage fluid as well. In endemic region young patients presenting with ulcer-proliferative growth on oropharynx, a high degree of suspicion for tuberculosis should be made. Early diagnosis and prompt treatment with anti-tubercular drugs results in a good treatment outcome with complete resolution of symptoms and signs.
  - 2,197 157
Role of dental physician in Marfan syndrome
Anusha Rangare Lakshman, Sham Kishor Kanneppady, Renita Lorina Castelino, Preethi Balan
January-June 2015, 3(1):110-112
DOI:10.4103/2321-4848.154959  
Marfan syndrome (MFS) is a variable, autosomal dominant disorder of connective tissue whose cardinal features affect the cardiovascular system, eyes, and skeleton. The patient's prognosis depends on the severity of cardiovascular complications and is mainly determined by progressive dilation of the aorta. If signs of MFS are recognized, it is important to refer to the correct health care professional for further testing to prevent associated complications. Hereby, we report a case of MFS who was unaware about the cardiac manifestations, thereby emphasizing the importance in identifying this potentially life-threatening condition in dental practice.
  - 2,752 174
Asymptomatic reversible lesion on tongue: A case series in pediatric patients
Vela D Desai, Swati Phore, Pallavi Baghla
January-June 2015, 3(1):113-116
DOI:10.4103/2321-4848.154960  
Tongue is a sensitive organ of the oral cavity that is responsible for many vital functions like taste, swallowing, speech, mastication, speaking and breathing. Geographic tongue is a frequently encountered oral condition with a controversial etiology. Since it is an asymptomatic condition known to resolve completely on its own, it is usually discovered during routine clinical examinations. Furthermore, it warrants treatment only when it becomes symptomatic. It can be present on any surface of the tongue but the commonest site is dorsal surface, where it characteristically presents with a migratory pattern that changes in location. This case report describes the uncommon occurrence of the tongue lesion diagnosed in children which is seldom reported in the pediatric literature.
  - 10,717 314
Prosthetic management of congenital anophthalmia-microphthalmia patient
Himanshi Aggarwal, Pradeep Kumar, Raghuwar D Singh
January-June 2015, 3(1):117-120
DOI:10.4103/2321-4848.154961  
Congenital anophthalmia and microphthalmia are rare developmental defects of the globe that cause deficient orbitofacial growth and impaired visual capability. Anophthalmia whether congenital or acquired is not just a question of cosmesis. It has many ramifications such as monocular status, loss of facial esthetics and psychological challenges for a growing child. The management of such a patient requires the coordinated involvement of a multidisciplinary team of health care professionals, including pediatrician, pediatric ophthalmologist, geneticist, genetic counselor, oculoplasty surgeon, and prosthetist. This article focuses on the rehabilitation of an adult female patient with congenital anophthalmia who was successfully treated with progressive expansion therapy with custom conformer followed by custom ocular prosthesis.
  - 3,706 261
Peripheral venous malformations and pulmonary hypertension: A case report and literature review
Nambakam Tanuja Subramanyam, Girish P Vakrani, R Veena, Shashidaran
January-June 2015, 3(1):101-105
DOI:10.4103/2321-4848.154957  
Extensive pure peripheral venous malformations are rare. We report occurrence of peripheral venous malformations associated with pulmonary hypertension in a middle-aged male, who had nodular, irregular, soft, compressible, painless, non-pulsatile swellings over dependant positions such as forearms, hands, axilla, and genitalia, with overgrowth of hands and fingers enlarging slowly since early childhood. He had right ventricular failure signs. Plain films showed soft-tissue mass with diffuse calcifications (phleboliths). Doppler study showed low flow vascular channels, compressible hypoechoic lesions along with occasional hyperechoeic lesion corresponding with phleboliths. Magnetic resonance imaging (MRI, T1-weighted) showed polypoidal mass with heterogenous hypo to intermediate signal with no flow voids. T2-weighted MRI showed high-signal intensity mass. Computed tomography (CT) pulmonary angiogram showed pulmonary hypertension, no thrombi or vascular malformation. He was treated with angiotensin-converting enzyme inhibitors, diuretics, amiodarone, antiplatelets, and venous stockings. Specific therapy such as sclerosis and surgical resection could not be done as he was discharged against medical advice.
  - 2,088 143
Fusion of deciduous central incisors
Imran Mohtesham, Moidin Shakil, Maji Jose, Vishnudas Prabhu
January-June 2015, 3(1):85-87
DOI:10.4103/2321-4848.154951  
Fusion is a common dental anomaly affecting both primary as well permanent dentitions. Fusion is the union between two normally separated tooth germs. The problems associated with fused teeth are esthetics, arch symmetry, spacing, and malocclusion. These problems require cosmetic and orthodontic consideration.
  - 2,050 188
Aggressive angiomyxoma of vulva: A case report and review of literature
Bhakti Dattatraya Deshmukh, Medha P Kulkarni, Yasmin A Momin, Kalpana R Sulhyan
January-June 2015, 3(1):88-90
DOI:10.4103/2321-4848.154952  
Aggressive angiomyxoma is a distinctive, locally aggressive, mesenchymal tumor that preferentially involves the pelvic and perineal regions of females with a peak incidence in the 4 th decade of life. The neoplastic cells of aggressive angiomyxoma exhibit fibroblastic and myofibroblastic features and appear to be hormonally influenced. There is a strong propensity for local recurrence. The recurrence may be seen years after the initial resection; hence, long-term follow-up is required. We report a case of a 22-year-old woman with a huge pedunculated aggressive angiomyxoma arising from right labia majora.
  - 4,041 206
Diagnostic dilemma in Evans syndrome
Harish Chandra, Smita Chandra, Anita Sharma
January-June 2015, 3(1):91-93
DOI:10.4103/2321-4848.154953  
Evans syndrome, a complex uncommon disease, poses a great diagnostic dilemma due to its variable presentation. The present case of 26-year-old Indian female faced similar difficulty as it was not diagnosed initially when it presented with thrombocytopenia and was treated by platelet concentrate transfusion and steroids. However, the patient showed repeated episodes of remissions and exacerbations without any substantial improvement and later at a tertiary care center it was diagnosed as Evans' Syndrome after direct antiglobulin test and relevant investigations to rule out other causes. This case stresses on the importance of direct antiglobulin test in every patient presenting with autoimmune thrombocytopenia to rule out autoimmune hemolytic anemia and thus excluding this syndrome.
  - 3,425 303
Malignant proliferating trichilemmal tumor of the scalp with secondary infection in an elderly man
Saptarshi Paul, Harishchandra Badekila, Anantha Prabhu Kumble
January-June 2015, 3(1):94-96
DOI:10.4103/2321-4848.154954  
A 65-year-old man presented with the complaints of a growth on the scalp, which ruptured spontaneously leading to bleeding and foul smelling discharge associated with severe pain. Examination revealed ulceroproliferative growth with slough and surrounding induration, infested with maggots. Histopathological examination revealed proliferating trichilemmal tumor (PTT) with secondary infection. Wide excision of the tumor was done with 1 cm margin all around it. PTT is a benign neoplasm that can rarely undergo malignant transformation thought to originate from trichilemmal cyst. Malignant PTT (MPTT) predominantly affects the scalp, eyelids, neck, and face and the treatment recommended being a wide local excision.
  - 3,294 193
Plant growth nutrient (nitrobenzene) poisoning with multiple complications
Yatendra Singh, Makrand Singh, Sandeep Raj Saxena, Khalil Mohammad
January-June 2015, 3(1):97-100
DOI:10.4103/2321-4848.154956  
Nitrobenzene, a pale yellow oily liquid with an odor of bitter almonds, is used in the synthesis of Aniline dyes, flavoring agent, and also in rubber industry. Recently it is also used as a plant growth nutrient. It causes methemoglobinemia with symptoms including headache, nausea, dizziness, fatigue, shortness of breath, cyanosis, and convulsions. Severe acute exposure to nitrobenzene can cause jaundice, renal failure, and coma, and it may be fatal. We report a case of Plant growth nutrient (nitrobenzene) poisoning with multiple complications like hemolytic anemia, renal failure, seizures, and pneumonia. Patient was managed with intravenous methylene blue along with other supportive therapy and survived. So, early aggressive management and a watch on complications might be helpful in saving patient's life from this poisoning.
  - 12,885 387
EDITORIAL
Torchbearers of humanism and spiritualism to foster the healing encounter in 21 st century medicine
Bhaskara P Shelley
January-June 2015, 3(1):1-3
DOI:10.4103/2321-4848.154916  
  - 2,597 319
INVITED EDITORIAL
Evolutionary mismatch
BM Hegde
January-June 2015, 3(1):4-5
DOI:10.4103/2321-4848.154917  
  - 2,534 298
LETTERS TO THE EDITOR
Glimpses under the history of medicine
Abhay B Mane
January-June 2015, 3(1):159-159
DOI:10.4103/2321-4848.154972  
  - 1,538 115
Giant malignant solitary fibrous tumor: A rare thoracic mass in a patient of neurofibromatosis 1
Arjun Khanna, Jagdish Chander Suri, Animesh Ray, Pooja Taneja
January-June 2015, 3(1):160-161
DOI:10.4103/2321-4848.154973  
  - 1,648 111
MEDICAL EDUCATION
Introducing innovative crossword puzzles in undergraduate physiology teaching- learning process
Latha Rajendra Kumar, Shobith Bangera, Padmini Thalenjeri
January-June 2015, 3(1):127-130
DOI:10.4103/2321-4848.154964  
Background: Games in physiology form an interesting avenue for teaching - learning process as it evokes interest, motivates students and is a welcome change in the monotonous routine lecture. Objective: To assess the usefulness of using crossword puzzles as a method of teaching and learning physiology among medical students. Materials and Methods: A simple crossword with clues given "across" and "down" was made using the puzzle maker website. Students were given instruction on the game rules and divided into teams. The students enjoyed the 2-hour game module and feedback from students was taken on the conduction of the crossword game and the interest generated. Results: Most of the students agreed that the game was conducted well and it was an extremely useful, fun filled, focused and an innovative change introduced by the department of Physiology. All of them gave written feedback and said they wanted more of such games. Conclusion: Using innovative interesting methods in teaching and learning programs is useful in creating interest among the students towards studying.
  - 3,694 256
MEDICAL HISTORY
Rudolf Carl Virchow: A multifaceted personality
Prema Saldanha, Julian Saldanha
January-June 2015, 3(1):145-147
DOI:10.4103/2321-4848.154967  
  - 6,328 238
Looking back at painless surgery
P Chandramohan
January-June 2015, 3(1):148-151
DOI:10.4103/2321-4848.154968  
  - 1,909 135
Miswak: The miracle twig
Akhter Husain, Salman Khan
January-June 2015, 3(1):152-154
DOI:10.4103/2321-4848.154969  
  - 4,441 286
ORIGINAL ARTICLES
Awareness of female breast cancer among adult males in Mumbai, India
Shivani Chowdhury Salian, Farhin Narsinh, Sujata Yardi
January-June 2015, 3(1):18-23
DOI:10.4103/2321-4848.154920  
Background: Breast cancer is a major killer disease in females globally and in developing regions, where the early cancer detection facilities are unavailable, prognosis is even worse. Awareness about this disease can lead to early detection and thereby decrease the morbidity and mortality. Materials and Methods: In a longitudinal prospective survey, 150 adult males were interviewed regarding their awareness about occurrence of breast cancer in females using a self designed and validated questionnaire. A battery of questions aiming to assess the levels of awareness of adult males regarding risk factors, signs and symptoms, importance of early detection, methods of detection, treatment options and importance of exercise were considered. Results: This study presented demographic and qualitative information about the levels of awareness about a disease that is alarmingly increasing in women population in India. The results showed that 18% of the targeted adult male population had good awareness, 45% of males had an average awareness and 37% of adult males had poor awareness about breast cancer in females with respect to the domains considered in the survey questionnaire. Conclusion: Breast cancer awareness is very low among men in a metropolitan city like Mumbai. In the absence of breast cancer screening clinics, there is a dire need to take measures to improve breast cancer awareness in men so that they can play a role in early detection of this disease and thereby improve the outcome in this disease.
  - 4,023 330
Variation in the serum bilirubin levels in newborns according to gender and seasonal changes
Jyoti Bala, Yuthika Agrawal, Kiran Chugh, Meenakshi Kumari, Vipin Goyal, Pardeep Kumar
January-June 2015, 3(1):50-55
DOI:10.4103/2321-4848.154945  
Introduction: Bilirubin is a substance that is produced during the process of hemolysis. Gender influences on neonatal illnesses and outcomes have remained a topic of debate and investigation. Empirical neonatological experience suggests that prevalence and degree of neonatal jaundice might be dependent on seasonal variation also. The aim of our study is to interpret the bilirubin levels in newborns according to gender and seasonal variation. Materials and Methods: The study was done from October 2012 to July of 2013 (differentiated by seasonal variation). A total of 1000 jaundiced newborn (500 of each sex diagnosed clinically and divided equally in summer and winter season) were studied to assess the total, direct and indirect serum bilirubin levels using colorimetry. Results: Out of total 1676 deliveries (439 were caesarean, 13 were assisted and rest were normal) during winter season and 1475 deliveries (399 were Cesarean, 14 were assisted and rest were normal) during summer season, 500 male newborn and 500 female newborn were analysed, divided equally in both seasons. Serum bilirubin was higher in males in summers and mainly comprised unconjugated bilirubin while direct bilirubin was higher in females in winters. Raised indirect bilirubin was more common in males born in summer than those born in winters (P = 041). In winters raised direct bilirubin was more common in females as compared to males (P = 0.019). Among female neonates total and indirect bilirubin was significantly raised in those born in summers (P = < 0.001 and <0.001, respectively) while direct was raised in those born in winters (P = 0.003). Conclusion: Physiological and pathologic phenomena associated with male gender must be integrated in the frame of understanding of both susceptibility and protection of the male newborn which has not been available for adequate investigation in the past. The higher temperature during the summer, with a greater influence of higher breastfeeding cause more severe hyperbilirubinemia.
  - 5,751 281
Occurrence of shoulder disorders among postcoronary artery bypass surgery patients in India
Shifa Manhal, Mohamed Sherif Sirajudeen, Padmakumar Somasekharan Pillai, Harish R Nair, Jayashankar Marla
January-June 2015, 3(1):34-39
DOI:10.4103/2321-4848.154941  
Background: The range of motion and function of the shoulder girdle and upper back are believed to be impaired following coronary artery bypass graft surgery (CABG) through median sternotomy. Until date, there is no study published in India, which determines the occurrence of shoulder disorders in CABG patients. Objective: To determine the occurrence of shoulder disorders among post-CABG patients and to explore the associated factors. Materials and Methods: In this cross-sectional survey, 45 postoperative CABG patients were recruited. Details regarding demographic data, operative data, pre-and post-operative physiotherapy management and the occurrence of shoulder disorders were collected by face-to-face interview method using a questionnaire specifically designed for this study. Results: The occurrence of shoulder disorders among post-CABG patients was 36%. Predominance of shoulder disorders was found at the time point 3-4 months after CABG. No significant association was found between age, gender and performance of upper limb exercises and the occurrence of shoulder disorders. Conclusion: Given the high occurrence of shoulder disorder, it is crucial that rehabilitation professionals take essential steps to assess and treat these complications in the immediate postoperative period and continue the same following discharge from the hospital. The paper concludes by calling for further research to explore and develop a more directed prophylactic exercise regimen for the musculoskeletal complications following CABG.
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Videofluoroscopy versus upper G.I. endoscopy: A comparative study as a diagnostic tool in patients presenting with dysphagia
Sharwak Ramlan, Sai Manohar, Gangadhara Somayaji
January-June 2015, 3(1):6-11
DOI:10.4103/2321-4848.154918  
Background and Objective: Dysphagia is a major symptom in many of the patients coming to the hospital. There can be various causes of dysphagia and its accurate diagnosis shows the way for the necessary treatment. Videofluoroscopy and upper gastrointestinal (GI) endoscopy are the two most commonly employed primary investigating modalities in assessing dysphagia. The objective of the study was to compare videofluoroscopy and upper GI endoscopy and establish a primary diagnostic tool for assessment of dysphagia. Materials and Methods: A prospective study was conducted on 20 patients presenting with dysphagia in a tertiary care hospital.They were evaluated both by videofluoroscopy and upper GI endoscopy. Patients were evaluated based on the accuracy of the findings obtained with both the tests and compared statistically. Results: Videofluoroscopy could successfully diagnose 83% of the cases with a positive cause of dysphagia whereas upper GI endoscopy could diagnose only 41% of the positive cases. Conclusion: This study shows that videofluoroscopy is an effective primary diagnostic tool for evaluating dysphagia.
  - 5,061 454
A cross-sectional retrospective study to assess the pattern of prescribing for inpatient hypertensive cases in a tertiary hospital and to find out the possible avenues for betterment of hypertension management
Sandeep Kumar Gupta, Roopa P Nayak, R Rahavi, Amit Kumar
January-June 2015, 3(1):60-65
DOI:10.4103/2321-4848.154947  
Objective: The primary objective of this study was to characterize the prescribing pattern of antihypertensive agents in the tertiary care teaching hospital. The secondary objective of this study was to assess the appropriateness of the prescribing pattern of antihypertensive drugs as per the seventh report of the Joint National Committee (JNC-7) guidelines. Materials and Methods: A cross-sectional, retrospective study for the period of 7 months (June 2012 to January 2013) was conducted. Only inpatient hypertensive cases suffering from essential hypertension with or without other comorbid conditions were included in the study. Results: A total of 261 hypertensive patients on treatment, of which 57.9% were females and 42.1% males, were included. Hypertension alone was present in 26.8% of the patient whereas diabetes mellitus was the most common comorbid condition in 18.8% of the cases. Of the 261 patients studied, 47.1% were on monotherapy and 52.8% on combination therapy. The commonest monotherapy agents being prescribed were calcium channel blockers (CCBs) (26.8%), followed by diuretic (9.6%), angiotensin-converting enzyme inhibitor (ACEI) (5%), beta blockers (BBs) (3.8%) and angiotensin receptor blockers (ARBs) (1.9%). The commonest two drug therapy was with CCB and diuretic (15.7%), followed by CCB and BB (7.3%), CCB and ACEI (4.2%), ACEI and diuretic (3.4%), ARBs and diuretic (2.7%), BBs and diuretic (1.9%). The commonest three drug therapy was with CCBs, BBs, and diuretic (4.2%). Conclusion: The most favored class of antihypertensive drugs, either as monotherapy or combination therapy in hypertensive patients with or without comorbidities was CCBs. There was underutilization of thiazide diuretics, ACEIs and BBs in this study. Overall the general pattern of antihypertensive prescribing in this study is only partly in accordance with the guidelines of JNC-7.
  - 3,739 314
REVIEW ARTICLES
Oral health management considerations in patients with diabetes mellitus
Sandeep Kaur, Kirandeep Kaur, Shalu Rai, Rajat Khajuria
January-June 2015, 3(1):72-79
DOI:10.4103/2321-4848.154949  
Diabetes mellitus (DM) is one of the most serious diseases of metabolism. Long-term consequences of hyperglycemia are very heterogeneous and affect partially all tissues and organs of the organism. A number of oral diseases and disorders have been associated with DM, and periodontitis has been identified as a possible risk factor for poor glycemic control and the development of other clinical complications of diabetes. In this review article, we discuss the relevant information about DM associated oral conditions and role of dental practitioners to take the responsibility to develop programs to educate the public about the oral manifestations of diabetes and its complications on oral health in order to promote proper oral health and to reduce the risk of oral diseases.
  - 7,164 886
Role of calcium-enriched mixture in endodontics
Pradeep Kabbinale, KC Chethena, MA Kuttappa
January-June 2015, 3(1):80-84
DOI:10.4103/2321-4848.154950  
Calcium-enriched mixture (CEM) has been recently introduced as a hydrophilic tooth-colored cement. The CEM cement powder is composed of calcium oxide, calcium sulfate, phosphorus oxide, and silica as major elements. CEM is alkaline cement (pH~11) that releases calcium hydroxide (CH) during and after setting. The physical properties of CEM, such as flow, film thickness, and primary setting time are favorable. This cement is biocompatible and induces formation of cementum, dentin, bone and periodontal tissues. This novel cement has an antibacterial effect comparable to CH and superior to mineral trioxide aggregate (MTA) and sealing ability similar to MTA. Its clinical applications include pulp capping, pulpotomy, root-end filling and perforation repair. This review describes the composition, properties and clinical applications of CEM in endodontics.
  - 3,995 454
SHORT COMMUNICATIONS
An innovative approach in health sciences: Yoga for obesity
Sharma Dushyant, Tekur Padmini, Tikhe Sham Ganpat, Nagendra Hongasandra Ramarao
January-June 2015, 3(1):162-164
DOI:10.4103/2321-4848.154974  
Obesity is a global health burden and its prevalence is increasing substantially due to changing lifestyle. A yoga-based lifestyle intervention appears to be a promising option in obesity. The present study is designed to assess the effects of Integrated Approach of Yoga Therapy (IAYT) in patients with obesity. Twenty-four obese patients (8 males and 16 females) between18 to 60 years were assessed on the first and last day of a 7 days' residential intensive IAYT program. The body mass index (BMI), waist circumference (WC), hip circumferences (HC), and mid-arm circumference (MC) were recorded before and after the IAYT program. Paired Samples t test (Statistical Package for the Social Sciences, SPSS-16) was used to compare the means before (pre) and after (post) the intervention. The statistical analysis showed that there was a significant (P < 0.01, all comparisons) decrease (Ϳ) in mean body weight from 86.52 ± 15.23 to 84.54 ± 14.95 (2.29% Ϳ), mean BMI from 32.04 ± 5.02 to 31.30 ± 4.88 (2.33% Ϳ), WC by 3.46% Ϳ, HC by 4.65% Ϳ, and MC by 4.74% Ϳ. The results suggest that IAYT program was beneficial for patients with obesity and may offer better option to obesity-related problems. Randomized control trials are needed before a strong recommendation can be made.
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Fostering community and environment friendly disposal of biomedical wastes
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
January-June 2015, 3(1):165-167
DOI:10.4103/2321-4848.154975  
Health care waste is the waste generated from any health care activities in health care organizations, research institutes or laboratories. Almost, three-fourth of the health care wastes is nonhazardous, while the remaining fraction is hazardous, and is referred as biomedical waste (BMW). Inappropriate management of BMW is associated with significant potential risks to the health care workers, patients, communities, their future generations and their environment. To ensure the correct disposal of the generated BMW, they have been categorized in different classes and appropriate methods of disposal have been specified to prevent a health hazard to the health care providers and the general community. In addition, to render the BMW produced from a health care setting implementation of multiple measures have been proposed to reduce the menace of public health concerns. To conclude, to mitigate the magnitude of the health concerns emerging secondary to the improper disposal of BMW, development of a comprehensive waste management policy, in addition to establishing training programs for all healthcare workers is the need of the hour.
  - 2,123 173
TEACHING IMAGES
Painful knee: Is the anterior cruciate ligament torn?
Chandrashekhar A Sohoni
January-June 2015, 3(1):155-156
DOI:10.4103/2321-4848.154970  
  - 3,488 133
Sinus fungal ball
KS Gangadhara Somayaji, Rajeshwary Aroor, A Mohammad Nalapad, Shreepad Shetty
January-June 2015, 3(1):157-158
DOI:10.4103/2321-4848.154971  
  - 1,913 118
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