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   Table of Contents - Current issue
July-September 2017
Volume 12 | Issue 3
Page Nos. 161-228

Online since Friday, February 2, 2018

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A clinical study of self-stigma among the patients of schizophrenia and alcohol dependence syndrome Highly accessed article p. 161
Lipsy Modi, Imran Ali Shivji, Prakash B Behere, Kshirod K Mishra, Pradeep S Patil, Arvind Goyal
Background: Most patients with mental illness hesitate to use health services mainly because of two reasons. First, they do not want to be labeled as a “Mental Patient” and second to avoid the consequences associated with stigma. With this study, we intend to compare self-stigma between two illnesses and correlate it with sociodemographic and clinical variables. Materials and Methods: The study was conducted on consecutive male and female patients (50 with a diagnosis of schizophrenia and 50 with alcohol dependence syndrome as per International Classification of Diseases-10 diagnostic criteria), evaluated on sociodemographic pro forma and Internalized Stigma of Mental Illness Scale. Results: The total stigma scores were significantly different for all the three age groups, being more in the patients of age <30 years (2.78 ± 0.51) than the patients of other age groups. Furthermore, patients belonging to rural locality (2.77 ± 0.41) had higher scores than the patients from urban locality (1.92 ± 0.49). Patients with alcohol dependence syndrome (2.66 ± 0.54) had significantly higher total stigma scores than patients with schizophrenia (2.29 ± 0.59). However, patients with schizophrenia (2.55 ± 0.39) had higher scores on subscales of stigma resistance than of patients with alcohol dependence (2.34 ± 0.51). Conclusion: Patients with alcohol dependence experience higher level of self-stigma as compared to patients suffering from schizophrenia. Future research in stigma needs to be clinically driven and should help to develop standards of care because self-stigma acts as barrier which prevents people with mental illness to use health services consequently affecting the course and prognosis of their illness.
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A comparative study to evaluate the efficacy of butorphanol as an adjuvant to epidural analgesia for rib fractures p. 166
Virendrakumar Belekar
Background: Pain management through epidural catheters has emerged as optimal method of pain control in patients with rib fractures. This study was done to evaluate the efficacy of butorphanol in this subset of patients. Materials and Methods: Sixty patients were randomly allocated in two Groups R and B. Group R patients received 0.2% ropivacaine epidurally (10 mL) while Group B patients who received 0.2% ropivacaine and 1 mg butorphanol epidurally (10 mL). Baseline respiratory rate, oxygen saturation, partial pressure of oxygen, visual analog score (VAS), and peak inspiratory flow rate were noted in both the groups. Results: There was a significant increase in duration of analgesia and nonsignificant reduction in VAS score in Group B and nonsignificant decrease in invasive ventilation cases and significant reduction in length of Intensive Care Unit (ICU) stay in Group B. There were no significant adverse effects in both the groups except for nausea in Group B. Conclusion: Butorphanol as an adjuvant to epidural analgesia leads to better oxygenation, decreased length of ICU stay, and duration of mechanical ventilation without increase in significant side effects.
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Immunohistochemical analysis of tumor-associated stroma in oral squamous cell carcinoma with and without preexisting oral submucous fibrosis p. 170
Hande Harish Alka, Zade Rangrao Prajakta, Chaudhary S Minal, Gawande N Madhuri, Patil Swati, Agarwal Aakruti
Context: It has been proposed that oral squamous cell carcinoma (OSCC) arising in preexisting oral submucous fibrosis (OSMF) constitutes a clinicopathologically distinct disease than the OSCC arising without OSMF. Expression of myofibroblasts is an early event in tumorogenesis, and its expression in malignant lesions has been suggested to represent an important participant in invasion. Aim: To evaluate the expression of myofibroblasts in OSCC arising in OSMF and OSCC without OSMF. Settings and Design: Thirty each histopathologically proven cases of OSMF, OSCC with OSMF, and OSCC without OSMF were included in the study. The tissue sections were studied for histopathological evaluation and alpha-smooth muscle actin (α-SMA) expression. Statistical Analysis Used: Descriptive and inferential statistics using Kruskal–Wallis test, Mann–Whitney test, and Chi-square test. Results: The expression of α-SMA was found to be high in OSCC with OSMF and OSCC without OSMF group as compared to OSMF group. However, the difference between α-SMA expression in OSCC with OSMF and OSCC without OSMF group was found statistically nonsignificant. Comparison of α-SMA score with histopathological grading and tumor, node, metastasis staging in OSCC with OSMF and OSCC without OSMF groups showed statistically nonsignificant difference, whereas comparison of α-SMA score with lymph node metastasis was statistically significant. Conclusion: The altered extracellular matrix in OSCC with OSMF could be responsible for modified epithelial–mesenchymal transition, which is further proven by reduced intensity and distinct pattern of α-SMA staining in OSCC with OSMF.
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Correlation between dermatoglyphic pattern of right thumb; learning methodologies; and academic performance of medical students Highly accessed article p. 177
Satheesha B Nayak, Jeevan Velan, Ng Leong Shern, Loi Fuang Zoung, Abihirami Jeyarajan, Ashwini P Aithal
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: A total of 143 medical students voluntarily participated in this study. Ethical committee clearance was obtained before the study. Validated questionnaires were distributed to the students, and their right-handed 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, surfing internet for learning was 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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An epidemiological study of acute malnutrition in children of age 6 months to 5 years in an Urban Slum of Mumbai, Maharashtra p. 181
Durgesh Prasad Sahoo, Armaity Dehmubed, Mahesh B Jajulwar
Introduction: Malnutrition continues to be one of the major causes of morbidity and mortality among under-five children in developing countries. There are numerous factors that directly or indirectly affect the nutritional status of the children. Aim: This study aims to study the prevalence and associated risk factors of acute malnutrition in children 6 months to 5 years of age in an urban slum. Subjects and Methods: This community-based cross-sectional study was carried out in an urban slum in Mumbai. A total of 270 children of age 6 months to 5 years were enrolled in the study. Samples were selected by simple random sampling from various sectors. All mothers/informant were interviewed, and anthropometric measurements were recorded. Data were analyzed using SPSS version 20.0 and Chi-square test was used to find out the association between two qualitative variables. Results: The prevalence of underweight, stunting, and wasting were 52.2%, 42.2%, and 50.4%, respectively. The factors associated with acute malnutrition were age of the child, mother's educational status, occupation of mother, type of family, socioeconomic status, age at marriage below 18 years, children who were given prelacteal feeds, were not exclusively breastfed and were partially immunized. Conclusions: The findings of the present study revealed that higher prevalence of acute malnutrition was found in the children of urban slum in Mumbai. Socioeconomic development along with counseling on breast-feeding practices and nutrition education among the urban slum masses needs to be ensured which is an important factor to combat malnutrition.
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Morphometric measurement of fetal femur length for the prediction of gestational age in the IInd and IIIrd trimester of pregnancy by ultrasonography p. 187
Monalisa Roy, Ujwal L Gajbe, Brij Raj Singh, Priti Thute
Introduction: Femur length (FL) is a fetal biometric parameter used for estimation of gestational age. Gestational age determination by ultrasonography (USG) is very essential as it gives an accurate estimation. Aim and Objectives: This study is an attempt to measure FL of the fetus for the prediction of gestational age in the IInd and IIIrd trimester of pregnancy by USG. Materials and Methods: Five hundred pregnant women in the IInd and IIIrd trimester with the single live fetus and having no other complications either in mother or fetus, were selected for the study. Fetal FL was measured, and results were analyzed for accuracy in estimation of gestational age and were compared with findings of other workers. Observation and Results: Gestational age estimated from FL in 500 cases between 20 and 36 weeks of gestation showed that in the mean FL in each week of gestation the maximum difference of ±0.7 mm was found in the IInd trimester and ±2 mm was in the IIIrd trimester. The accuracy of the correctly diagnosed cases and P value decreases as pregnancy advance. Conclusion: Sonographic examination was found to be effective to assess the accurate FL parameter for different weeks of gestation. FL was found to be more appropriate in predicting gestational age in the IInd trimester and its reliability decreases in the IIIrd trimester.
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Clinical profile of pediatric head injury p. 191
Aashay S Nitnaware, Jayant Vagha, Revat Meshram
Introduction: Head injury in pediatrics is considered to be a major health problem that is a frequent cause of death and disability and makes considerable demands on health services. In developing countries accident rates in general and traumatic brain injury (TBI) in particular are increasing as traffic increases besides other factors such as industrialization, falls, and ballistic trauma. Aim: The aim is to study the clinical profile of children with head injury. Objectives: (I) Study the etiology of head injury in children >16 years admitted in our hospital. (II) Study the clinical course and management of patients during the hospital stay. Materials and Methods: Place of Study: AcharyaVinobaBhave Rural hospital, Sawangi, Wardha. Study Design: Prospective observational study. Study Duration: July 1, 2015–June 31, 2016. Sample Size: Fifty. Result: As per my survey, fall from height as the most common cause of pediatric head injury with male predominance, followed by road accidents various other. The most common lesion seen on computed tomography scan was an extradural hematoma, and frontal lobe being the most common site. Conclusion: TBI in rural areas is mostly among the young male population and is increasing every year with majority coming from nearby villages which is very alarming and highlights the need for taking urgent steps for establishing good prehospital care and provision of trauma services at site in India.
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Endoscopic evaluation of patients presenting with dysphagia at rural Hospital AVBRH p. 196
Siddharth Sahu, KS Kher, DD Wagh, Manish Swarnakar, Priyansh Pandey, Ishan Agnihotri
Background and Objectives: Dysphagia refers either to the difficulty someone may have with the initial phases of a swallow (usually described as “oropharyngeal dysphagia”) or to the sensation that foods and or liquids are somehow being obstructed in their passage from the mouth to the stomach (usually described as “esophageal dysphagia”). Upper gastrointestinal GI endoscopy is an important tool in the initial investigation of dysphagia. Endoscopy is indicated in patients with dysphagia to determine the underlying etiology, exclude malignant and premalignant conditions, assess the need for therapy, and perform therapy, such as dilation. Endoscopy-guided biopsy is indicated in structural causes observed during the endoscopic evaluation for confirming the diagnosis with histopathological correlation. Material and Methods: A study of 150 patients who presented with dysphagia, and the study focuses the importance of endoscopic (biopsy when needed) evaluation in these patients. Results: Study shows that the sensitivity of endoscopy was 1.000 (95% confidence interval [CI]: 0.942–1.000), specificity was 0.875 (95% CI: 0.787–0.936). The PPV was 0.849 (95% CI: 0.746–0.922). The NPV was 1.000 (95% CI: 0.953–1.000). Conclusion: Upper GI endoscopy is a safe and effective way to evaluate dysphagia and has both diagnostic and therapeutic value.
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From the perspective of lifeline express: Oral hygiene practices and reported barriers in rural India p. 206
Kuldeep Singh Shekhawat, Arunima Chauhan, Rajnish Gourh
Background: As India strives to achieve universal health coverage, improvement in oral health-care delivery through availability of skilled and motivated dental professional is essential. To provide effective oral care, understanding of the current oral hygiene practices and the existing scenario of oral care services is a must so that oral care can be customized for every geographical region keeping in mind the prevalent cultural trends. Aim: This study aimed to determine the oral hygiene practices of a section of rural population in India with the secondary objective to report barriers for utilizing oral health care. Material and Methods: A cross-sectional questionnaire study was conducted among 384 patients who reported to dental unit of Lifeline Express for treatment. Responses were obtained on a 5-item questionnaire consisting of items relating to their oral hygiene practices and consumption of tobacco and alcohol. History of dental pain in the preceding 12 months and reported barriers in utilizing oral health services were also elicited. The data were analyzed for descriptive statistics. Results: Only 52% cleaned their teeth using toothbrush and toothpaste. About 30% preferred traditional chewing sticks and 10% do not clean their teeth. About 36% reported consumption of tobacco and 85% experienced dental pain. Sixty-one percentage of patients did not visit dentist. Lack of knowledge, unavailability of dentist, and “no pain after the first visit” were the main reasons for not utilizing/further utilizing dental care. Conclusion: Our findings suggest encouraging traditional oral hygiene aid among rural population. There is a need to educate rural population which can help them overcome the reported barriers and utilize oral health services to the fullest.
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Correlation of the proliferative markers (AgNOR and Ki-67) with the histological grading of the glial tumors p. 211
Richa Jham, Samarth Shukla, Sourya Acharya, Shweta Dhote, Ankita Tamhane, Arvind Bhake
Aim and Objective: To analyze the correlation of histopathological grades of gliomas with histochemical and immunohistochemical proliferative markers like AgNOR and Ki-67 respectively. Materials and Methods: The present study comprised of 60 clinically suspected cases of glial tumors which were subsequently confirmed on histopathology as astrocytoma, oligodendroglioma and ependymoma. Statistical analysis was carried out using descriptive and inferential statistics using student's unpaired t test and One Way Analysis Of Variance (F-value). Results: On comparing the AgNOR score with histopathological grades of astrocytoma, it was found that AgNOR score increases with the grade of astrocytomas from I to IV. Similar results were seen with the grade II and III of oligodendrogliomas and ependymomas as well. When Ki-67 LI was compared to histopathological grades of gliomas, it showed a positive correlation. Conclusion: The present study concludes that there exists a positive correlation of histopathological grades of gliomas with AgNOR and Ki-67
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Correlation of various maternal factors with exaggerated hyperbilirubinemia of the newborn p. 218
Sneha Taneja, Vineeta Pande, Harish Kumar, Sharad Agarkhedkar
Background: Maternal factors could help determine the potential incidence of hyperbilirubinemia. This study was performed with the purpose of establishing the role of the various maternal factors previously indicated as being responsible for exaggerated physiological hyperbilirubinemia in term neonates with serum bilirubin level of 12 mg/dL or more. Materials and Methodology: It was a prospective, cross-sectional study conducted from July 2012 to August 2014 in Pimpri, Pune. A total of 2000 healthy term deliveries were screened, out of which 100 neonates with exaggerated hyperbilirubinemia were included. Data were collected with maternal information. The data were analyzed using t-test (for parametric distributions). Results: During the period of study, 330 babies out of 2000 deliveries had achieved the serum bilirubin level of >12 mg/dL. Thus, the prevalence of exaggerated neonatal hyperbilirubinemia in the current study was 16.5%. There is strong association between maternal infection and serum bilirubin even when only 5 mothers had infection (Z = 2.31 and P < 0.05), whereas no correlation was found with maternal diabetes mellitus, toxemia, and oxytocin infusion. Conclusions: Maternal infection was found to have a significant effect on neonatal exaggerated hyperbilirubinemia. Therefore, interventions should be prioritized to prevent maternal sepsis. The first approach targets facility-based deliveries and requires increased provision and uptake of proper antenatal care early in pregnancy.
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A case report of prolonged apnea during electroconvulsive therapy in a patient with suicidal attempt by organophosphorus poison p. 223
Karuna Taksande, Mansi Chatterjee, Vaibhav Jain
Electroconvulsive therapy (ECT) is a standard practice for psychiatric patients with suicidal behavior. Modified ECT with general anesthesia has evolved over inducing ECT without an anesthetic. The objective of anesthesia is to provide a rapid onset and offset of both unconsciousness and muscle relaxation for the duration of the electrical stimulus and subsequent seizure. Succinylcholine (0.5 mg/kg), due to its short period neuromuscular-blocking agent, is used to reduce muscular convulsion and decrease the risk of serious injury. Organophosphorus poisoning is an important cause for prolonged apnea following succinylcholine. We report a case of prolonged apnea after administration of succinylcholine for the ECT in a patient with a history of organophosphorus poisoning. A case of a 43-year-old male patient, residing at Nalavade, Wardha, previously hospitalized at Sevagram for organophosphorus poisoning which he had taken 11 days before. He was admitted and planned for intermittent modified ECT treatment. The patient was diagnosed with the major depressive disorder, and he was on medication for the same olanzapine. ECT was given. After the procedure, the patient was ventilated for 45 min. Since the patient did not regain spontaneous respiration, he underwent orotracheal intubation. The patient was then shifted to neuro-Intensive Care Unit for 4 h, and after the restoration of respiration depth and rate, and a normal arterial blood gas, the patient was extubated. The case of depression with suicidal tendencies was given modified ECT using low-dose suxamethonium. Apnea following suxamethonium was prolonged due to the recent intake of organophosphate poisoning. It is imperative to take detailed history including drug history to avoid such recurrences. It is mandatory in all cases with a recent history of organophosphate poisoning to estimate the plasma cholinesterase level before any anesthetic procedure.
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Giant enchondroma of the clivus p. 226
Amit Agrawal, Vissa Shanthi, Baddukonda Appala Ramakrishna
Enchondroma is a benign chondroid tumor which consists of mature hyaline cartilage and is common in the hands or feet (phalanges, metacarpals, and metatarsals). Enchondromas arising from the skull base are uncommon with only few reported cases in literature. We present the case of enchondroma arising from the clivus and discuss the clinical presentation and potential management options for this entity.
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