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   Table of Contents - Current issue
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October-December 2017
Volume 12 | Issue 4
Page Nos. 229-300

Online since Thursday, May 17, 2018

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ORIGINAL ARTICLES  

Study of motor nerve conduction velocity in patients of thyroid dysfunction in central India Highly accessed article p. 229
Avinash Baliramji Taksande, Arunita Tushar Jagzape, VK Deshpande
DOI:10.4103/jdmimsu.jdmimsu_100_17  
Background: Hypothyroidism is a clinical disorder due to the deficiency of thyroid hormone. This hormone is a key regulator of cellular metabolism in our body. Hypothyroid state is usually asymptomatic, symptoms in the early phase while associated with a number of symptoms later affecting skin, heart, endocrine, brain, and nerves. Hyperthyroidism is less commonly associated with neuromuscular disorders and polyneuropathy. Objective: The objective of the study was to assess motor nerve functions in thyroid dysfunction patients. Study Design: This study design was a comparative study. Population: The study population was clinically diagnosed thyroid dysfunction patients and healthy individuals. Sample Size: The sample size was 82 (41 each in cases and control group). Materials and Methods: Neuro Perfect 2 – Channel EMG NCV EP, Medicaid, instrument was used. Parameters such as distal motor latency (DML), compound motor action potential CMAP amplitude, conduction velocity (CV) for motor nerve, and F-wave minimum latency of motor nerve were recorded and analyzed. Results: The median motor nerve CV (MNCV) and F-minimum latency were significantly reduced in cases as compared to controls on the right side (P < 0.05). The MNCV, DML, and F-minimum latency were significantly reduced in cases as compared to controls on the left side (P < 0.05). Conclusion: The findings suggest that polyneuropathy is associated with hypothyroidism. Further nerve conduction study might be useful to evaluate and to diagnose peripheral neuropathy in hypothyroid patients.
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Extended spectrum β-Lactamases producing Klebsiella pneumoniae: A threat to patient care p. 234
Priyanka Singh, Silpi Basak
DOI:10.4103/jdmimsu.jdmimsu_19_18  
Background and Objectives: Extended spectrum β-lactamases (ESBL) producing Klebsiella pneumoniae strains are increasing worldwide and pose a major threat to patient care. Hence, the present study was undertaken to detect the incidence of ESBL producing K. pneumoniae strains isolated from different clinical specimens in the Department of Microbiology. Study Design: The study was approved by Institutional Ethical Committee. The type of study was cross sectional observational study. 120 K. pneumoniae strains were studied. Antibiotic susceptibility test was done by Kirby-Bauer disc diffusion method. ESBL production was detected phenotypically by confirmatory test e.g. combined disc method. Results: Out of 120 K. pneumoniae strains, 55 (45.8%) strains were ESBL producers. All 100% strains were sensitive to Colistin. Conclusion: Hence, to conclude, all K. pneumoniae strains, isolated in Clinical Microbiology Laboratory should be tested phenotypically for ESBL production.
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Correlation between dermatoglyphic pattern of right thumb, learning methodologies, and academic performance of medical students p. 238
Satheesha B Nayak, Jeevan Velan, Ng Leong Shern, Loifuang Zoung, Abihirami Jeyarajan, Ashwini P Aithal
DOI:10.4103/jdmimsu.jdmimsu_23_18  
Background: Dermatoglyphics is developing its importance in everyday life, and researchers are keen to unveil various unknown aspects of dermatoglyphics in biology, anthropology, genetics, and medicine. The present study was conducted to assess the relationship of thumbprint, learning methodologies, and academic performance of medical students. Methodology: Hundred and forty-three medical students were voluntarily participated in this study. Ethical committee clearance was obtained before the study. Validated questionnaires were distributed to the students and their right-hand thumbprints were collected simultaneously. The data were analyzed using Microsoft Excel. Results: The most common dermatoglyphic pattern observed among the students was whorls. Malays, Malaysian Indians, and Chinese mostly had whorl pattern, while among the Sri Lankans, the most common pattern was radial loop. A high percentage of students with ulnar loop scored distinction while students with other patterns mostly scored pass marks. Active learning strategies such as bringing reference books to class, revising previous chapters before class, taking notes in class, and surfing Internet for learning were seen mostly among the students with ulnar loop. Conclusion: Most of the students with whorl pattern were either in low or average scoring groups. Individuals with ulnar loop were significant for this study as they had higher scores and better learning methodologies compared to other students.
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Prevelance of tobacco use among school children reporting to dental hospital for treatment p. 242
Utkarsha Basakhetre, Ashish Jaiswal, Shravani Deolia, Sourav Sen, Malsawm Dawngliani, Arpan Jaiswal
DOI:10.4103/jdmimsu.jdmimsu_28_18  
Objective: The objectives of this study are to study the pattern of tobacco use in Indian school children aged 10–15 years in Wardha district and to study the role of psychosocial factors in initiation and prevention. Materials and Methods: A descriptive questionnaire cross-sectional study to evaluate the patterns of tobacco use in India among school children aged 10–15 in Wardha district. Results: Of the total of 1000 children selected, 5.9% were tobacco users and out of these 3.7% claimed to be addicted to it. Among the habitués, the mean age of initiation of tobacco use was 11.65 ± 2.62. The possible causes being peer pressure (35.08%), tension (49.12%), to achieve the aim (5.26%) and influence from parents (10.52%). Among the habitués, a mean number of 2.71 ± 2.03 children were using tobacco regularly with the range of 1–5 times per day. Conclusion: The peer group influence was the reason for initiating this habit in majority of the users. It is better to prevent the initiation of the habit than trying to stop the habit. The present study suggests the need for school-based tobacco prevention programs. Joint efforts from family, school, and social welfare groups are needed to address these factors for effective prevention, in addition to raising awareness against tobacco use among the school students.
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Serum prostate-specific antigen as a tumor marker for its correlation with histopathological diagnosis of prostatomegaly p. 246
Biswadeep Sarkar, Arvind Bhake
DOI:10.4103/jdmimsu.jdmimsu_29_18  
Background: Prostatomegaly is common in men past fifth decade of life and has been the most common cause of symptoms associated with lower urinary tract obstruction. The emergence of prostate-specific antigen (PSA) has come to rescue of clinicians at screening the prostate cancer by its raised value in serum. The further research over the PSA brought out few new indices which are sensitive in screening and suggesting prostate cancer such as the ratio between free and bound PSA, PSA density (PSAD), and PSA velocity. Objectives: The objective of this study is (1) to study serum PSA level and PSAD at the differentiation of benign prostatic hyperplasia (BPH), prostatic intraepithelial neoplasia, and prostatic carcinoma (PCa) established at prostatic tissue diagnoses, (2) evaluation of the significance of total prostate-specific antigen (TPSA) level in the intermediate range of 4–10 ng/ml at assessment of benign versus malignant prostatomegaly at tissue diagnoses, and (3) to draw cutoff values of PSAD (0.15 vs. 0.18 ng/ml/cc) in suggesting benign versus malignant prostatomegaly at tissue diagnoses. Materials and Methods: Digital rectal examination was carried out in suspected clinical cases of prostatomegaly. One hundred and eight cases of prostatomegaly have undergone TPSA estimation prospectively by Vidas TPSA kit. PSAD was calculated as the ratio between TPSA and the volume of the prostate. The sample received for histopathological diagnoses were either sextant biopsy (25 specimens), transurethral resection of prostate (68 specimens), and prostatectomy (15 specimens). Results: TPSA was performed in total 108 patients of prostatomegaly, of which 35 (40.22%) cases had TPSA in the range of ≤4 ng/ml, 37 (34.25%) cases had TPSA in the range of 4.01–10 ng/ml, and 36 (33.33%) cases had TPSA in the range of >10 ng/ml. The mean PSAD cutoff of <0.18 ng/ml/cc had revealed 79 (90.80%) cases of BPH. The mean PSAD cutoff of ≥0.18 ng/ml/cc had revealed 8 (9.1%) cases of BPH, 19 (100%) cases of PCa and 2 (100%) cases of prostatic intraepithelial neoplasia (PIN). Final tissue diagnoses in total 108 cases were as follows: BPH – 87 (80.55%) cases, PIN – 2 (1.85%) cases, and prostatic adenocarcinoma – 19 (17.59%) cases. Conclusion: The TPSA value over 10 ng/ml and mean PSAD value over 0.15 or over 0.18 ng/ml/cc can be used as criteria for prostatic biopsy. The mean PSAD cutoff of over 0.18 ng/ml/cc works superiorly for the diagnoses of malignant prostatomegaly, selection of the cases for the prostatic biopsy and medical or surgical management of prostatomegaly.
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Physical abuse, a harsh way to discipline children: A survey report from rural wardha p. 253
Vaishali Dinesh Tendolkar, Bhalchandra D Kulkani
DOI:10.4103/jdmimsu.jdmimsu_17_18  
Background: Child abuse, commonly used for disciplining the child, has serious physical and psychosocial consequences which adversely affect the health and overall well-being of a child. It is a violation of the basic human rights of a child and is an outcome of a set of interrelated familial, social, psychological, and economic factors. Child abuse leads to emotional, physical, economic, and sometimes legal consequences for the children aged 3–5 years. It is a globally prevalent and preventable phenomenon. Objectives: The objectives were: (1) To assess the parent reported physical abuse and (2) to find out the child reported physical abuse. Study Design: This was a survey study. Methodology: Physical abuse questionnaire. Sample: Children in the age group 3-5 years and their parents were chosen as the sample. Results: About 54.5% parents and 77.2% children reported that they slap their child once in a week. 4.5% children are slapped every day. 17% parents and 22% children reported pinching once to thrice a week. 51.5% parents and 28.5% children reported beating by parents at least once a week. Other forms of physical abuse such as starving the child, locking in dark empty room, restricting entry in the house, threatening, and scaring are also reported by parents as well as children. Conclusion: Slapping, pinching, beating, making the child starve, throwing the child away, threatening the child, and restricting them from mingling with others are common types of physical abuse by parents to children while disciplining children.
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Cholangiohepatitis: Radiological spectrum of the disease amid the rising prevalence in India: A case study in a tertiary institute in South India p. 261
Sonali Dattatray Prabhu, Dattatray A Prabhu, Sandeep N. R Gopal Krishna, Ashwini Kumar, Santosh P. V Rai, Ajit R Mahale
DOI:10.4103/jdmimsu.jdmimsu_34_17  
Introduction: There is a rising incidence of Oriental cholangiohepatitis (OCH) also known as recurrent pyogenic cholangitis (RPC), in Indian population. The condition which presents with classical triad of recurrent upper abdominal pain, obstructive jaundice and fever is characterized by biliary sludge, intrahepatic bile duct calculi, strictures, duct dilatation and cholangitis resulting from chronic biliary parasitic infestation and associated chronic secondary portal bacteremia. Aim: The purpose of this retrospective study was to understand the spectrum of radiological manifestations of oriental cholangiohepatitis by MRI which helps in differentiating it from other differential causes of biliary obstruction and cholangitis. Materials and Methods: This was a retrospective study of cases of oriental pyogenic cholangitis diagnosed by MRI over a period of 3 years in department of radio diagnosis who were referred from gastroenterology department with clinical suspicion of cholangitis and diagnosed as having OCH based on MRI finding's and later confirmed by ERCP or biochemical parameters. Results: Out of the total 950 MRCP scans evaluated, 150 cases were of suspected cholangitis and only 9 cases had features of oriental pyogenic cholangitis. These patients showed the characteristic MRCP finding's like ductal changes including intraductal calculi with dilatation and strictures in RHD and LHD, segmental and subsegmental IHBRs and in extrahepatic biliary tree i.e. CHD and CBD with decreased arborization of peripheral biliary radicals; wall thickening in biliary tree and pneumobilia; and parenchymal abnormalities like fatty liver, hepatomegaly, segmental atrophy or diffuse liver atrophy. Complications like portal hypertension, splenomegaly and ascites that occur were also observed. Though literature mentions complications like hepatic mass/SOL i.e. hepatic abscess or malignancy, we didn't have any in our case series. Conclusion: To summarise, presence of hepatolithiasis and choledocholithiasis with significant biliary duct dilatation and short segment strictures in the biliary tree with peripheral IHBR pruning, usually in the absence of gallstones on MRCP is nearly pathognomonic of oriental pyogenic cholangitis in patients presenting with classical clinical triad of abdominal pain, jaundice and fever and obviates the need for diagnostic ERCP.
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Knowledge, attitude, and practice toward avian flu among students in a public university in Pahang, Malaysia p. 269
Hanadi Ibrahim, Nor Azlina A. Rahman, Suhana Mamat, Mainul Haque
DOI:10.4103/jdmimsu.jdmimsu_69_17  
Background: Avian influenza (AI) is a disease that causes infection in birds with AI A virus. In Malaysia, the first outbreak of AI in poultry was detected in Kelantan on August 2004. This study aimed to examine the knowledge, attitude, and practice (KAP) toward AI among students in a public university in Pahang, Malaysia. Materials and Methods: This was a cross-sectional study had been conducted starting from March 11, 2013 until March 20, 2013 on 100 students. Data regarding sociodemographics characteristics and KAP toward AI had been collected by distributing the questionnaires to the participants in their hostels and classes and were analyzed using SPSS software. Results: The mean knowledge, attitude, and practice were 21.47 (4.181), 44.28 (4.845), and 8.69 (1.921), respectively. There were significant differences regarding the level of knowledge among different group of age (P = 0.041) and departments (P = 0.001). The older group of individuals were more knowledgeable. The students from health science had a higher level of knowledge. Regarding the practices, there was no significant difference in the level of practice toward the prevention of AI across the different gender, age, hometown, and department. There was also the significant correlation between knowledge and practices (r = +0.217, P = 0.030), but no association was found between knowledge and attitude or attitude and practice. Conclusion: Overall participants had moderate knowledge and practices regarding prevention of AI. Nonetheless, they had expressed good positive attitude toward the prevention of disease. Therefore, public health agencies should play a role to spread information and increase awareness among students about this infectious disease.
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Anatomical variations of ureter in central India: A cadaveric study p. 277
Monalisa Roy, Brij Raj Singh, Ujwal L Gajbe, Priti Thute
DOI:10.4103/jdmimsu.jdmimsu_73_17  
Background: Duplication of ureter is a developmental anomaly of urogenital system. The possible embryological reasons for the formation of a duplicated ureter could be splitting of ureteric bud, resulting two ureters draining into single kidney. Prevalence occurs in approximately 1% of the population. It may be associated with or without other congenital defects. Aim: To study the major anatomical variations of the ureter in routine dissection method. Materials and Methods: The present study conducted in the Department of Anatomy on 156 formalin-fixed cadavers of both sex and focus on the ureteric anomaly in routine dissection method. The ureter was followed from the renal pelvis to the uretrovesical junction, an opening into the urinary bladder (UB). Out of them, we got in one cadaver that two ureters were draining a single kidney into the UB separately and were not associated with any other congenital anomaly. There was complete duplication of ureter on unilateral side (left). Right kidney and its ureter were entirely normal. Conclusion: The knowledge of abnormality in renal collecting system is necessary for effective endo-urological applications and intrarenal surgeries. The present study adds on to the literature and will be helpful and interesting for the radiologists and urologists as it describes the ureteric anomaly in the Central Indian population.
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CASE REPORTS Top

The partial pressure of oxygen in arterial blood: A relation with different fraction of inspired oxygen and atmospheric pressures p. 280
NK Agarwal, Sumit Trivedi
DOI:10.4103/jdmimsu.jdmimsu_31_18  
As an anesthesiologist and critical care intensivist, it is mandatory to have thorough knowledge of variable partial pressure of oxygen, at different fraction of inspired oxygen (FiO2), and effect of various atmospheric pressures in alveoli, diffusion, and transport of oxygen to tissue. The partial pressure of oxygen in arterial blood gas shall always be expressed with respect to the atmospheric pressure and FiO2; unless these conditions are mentioned, one may not be able to assess the exact respiratory status of patient.
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Plexiform unicystic ameloblastoma: A rare variant of ameloblastoma p. 284
Suwarna M Bhalerao, Vidya K Lohe, Rahul R Bhowate, Swapnil C Mohod, Shraddha Patel
DOI:10.4103/jdmimsu.jdmimsu_30_18  
The term plexiform unicystic ameloblastoma (UA) refers to a pattern of epithelial proliferation that has been described in the cystic cavity. Due to the unilocular presentation, it is commonly misdiagnosed with an odontogenic (dentigerous) cyst. However, they may often behave clinically as biologically aggressive tumors. The location of the UA within the jawbones shows a marked predominance of the mandible irrespective of the variant. The posterior mandible, including the ascending ramus, is the region most often affected in both variants. In the present case too, the ramus was primarily involved. These tumors show a high incidence of cortical perforation, tooth resorption, and a high rate of recurrence after simple enucleation. Hence need to be carried out of segmental resection due to the extensive size of the lesion. This case report aims to provide an insight into this biologically and radiographically distinct entity. An accurate and timely diagnosis of the character and extent of UA should be done which is only possible after a thorough microscopic examination of the lesion. A literature review on the topic has been added along with a case report highlighting the approach of diagnosis and management of such ameloblastomas.
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Anesthetic management of chronic thromboembolic pulmonary hypertension for pulmonary endarterectomy p. 289
Nameirakpam Charan, Mangesh Choudhari, Manish Sonkusale, Rashmi Deshpande
DOI:10.4103/jdmimsu.jdmimsu_40_17  
Pulmonary endarterectomy (PEA) is considered treatment of choice for chronic thromboembolic pulmonary hypertension. The procedure dramatically improves functional status and provides an excellent immediate improvement and long-term survival, better than lung transplantation. PEA, until recently performed in only a few highly specialized centers, is now spreading worldwide with good results. We report successful anesthetic management of PEA under deep hypothermic circulatory arrest in our institute.
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Helmet-induced ocular trauma: A rare mechanism p. 292
Mohana R Majumdar, Mona P Sune, Pratik Mohod
DOI:10.4103/jdmimsu.jdmimsu_33_17  
A 32-year-old male presented with chief complaint of ocular injury in the left eye, in spite of wearing a helmet, in a road traffic accident. His uncorrected visual acuity in the injured eye was 6/9, and he had a full thickness lid laceration. There was a 25 mm upper eyelid laceration at the level of the eyebrow, splitting it horizontally. Early repair resulted in less tissue edema and better wound decontamination. We report this case to highlight an unusual mechanism of injury by the pro shield of a helmet and to show the need for eye protection in spite of wearing a helmet.
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CASE SERIES Top

Evaluation of effectiveness of platelet-rich fibrin for ridge preservation after atraumatic extraction: A case series p. 294
BS Shilpa, Prasad V Dhadse, Manohar L Bhongade, Sneha Puri, Jayshree Nandanwar
DOI:10.4103/jdmimsu.jdmimsu_20_18  
Purpose: The present study was undertaken to evaluate the effectiveness of platelet-rich fibrin (PRF) for ridge preservation after atraumatic extraction. Materials and Methods: Seven patients with a nonrestorable tooth requiring extraction followed by implant placement were treated in this study. After atraumatic extraction, the socket was filled with PRF as the sole grafting material in preparation of placing an implant after wound healing. At the time of extraction and 3 months later, vertical and horizontal socket dimensions were measured clinically and radiographically. Results: The measurements of buccolingual dimension of the socket immediately after extraction and at 3-month postsurgery were recorded. The mean buccolingual measurement of socket at baseline was 10.0 ± 1.6 mm. Postoperatively, 3 months after ridge preservation, the mean buccolingual measurement was 9.4 ± 1.6 mm showing minimal changes. The radiographic vertical bone level at baseline was 14.1 ± 1.0 mm and 3 months postoperatively 12.7 ± 0.8 mm showing minimal changes in apicocoronal dimension. Conclusion: The ridge preservation using PRF as space filler after atraumatic extraction was found to be an effective procedure for the placement of implants.
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