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   Table of Contents - Current issue
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October-December 2019
Volume 14 | Issue 4
Page Nos. 283-444

Online since Thursday, July 16, 2020

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ORIGINAL ARTICLES  

A cross-sectional study of comorbid depression in patients with chronic tension-type headache in psychiatry outpatient Highly accessed article p. 283
Ajinkya Ghogare, Ashish Saboo
DOI:10.4103/jdmimsu.jdmimsu_107_19  
Context: Headache is one of the most common reasons for which patients seek medical attention. Headache is a common neurological disorder that ranks among the top 10 most disabling conditions for both men and women worldwide. Psychiatric comorbidities have been commonly observed in patients with tension-type headache (TTH) and that may be explained by affective distress, personality disorders, and maladaptive coping. Aim: The aim was to study the prevalence and severity of comorbid depression in patients with chronic TTH. Materials and Methods: The present cross-sectional study was conducted at a tertiary health-care center in Central India, with a sample size of 95. Data from selected study participants were recorded in a predesigned, semi-structured questionnaire. The Hamilton Depression Rating Scale (HDRS) was used to categorize depression. Results: Out of total 95 study participants, majority (45 [47.4%]) were in the age group of 31–40 years, with a mean age of 36.67 years, a standard deviation of 7.14 years, and range between 21 and 56 years. Higher proportions of female study participants (67 [70.5%]) were observed than male study participants (28 [29.5%]). A majority of the study participants were married (74 [77.9%]) and 57 (60.0%) were employed. The prevalence and severity of depression, according to the HDRS, was mild depression in 31 (32.6%), followed by moderate depression in 16 (16.8%), and severe depression among 3 (3.2%) cases. Conclusion: TTH is associated with comorbid depression in 52.6% of the study participants. Married patients had high frequency of depression. No other sociodemographic characteristics were associated with the presence of depression.
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Sonography evaluation of abnormal uterine bleeding in perimenopausal women with pathological correlation Highly accessed article p. 288
Sakshi Daga, Suresh Phatak
DOI:10.4103/jdmimsu.jdmimsu_99_19  
Context: Ultrasound plays an important role in the diagnosis of structural or organic causes of abnormal uterine bleeding in perimenopausal females, thereby aiding surgeons and gynecologist to plan an appropriate management plan for patients. Aims: The aim of the present study was to evaluate the sensitivity and specificity of ultrasound in abnormal uterine bleeding in perimenopausal females with pathological correlation. Settings and Design: A prospective study was conducted over a period of 2 years from 2017 to 2019. Materials and Methods: A total of 82 perimenopausal females with complaints of abnormal uterine bleeding were selected for this study. Transabdominal scan and wherever required transvaginal scan were done to assess any organic cause of abnormal bleeding. Later on, findings on ultrasound were correlated on pathological studies. Statistical Analysis Used: Statistical analysis was performed using descriptive and inferential statistics using sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, descriptive statistics, and Chi-square test. Results: Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of ultrasound in comparison to pathological studies were found to be 86.96%, 84.62%, 96.78%, 55%, and 86.58%, respectively. Conclusions: Ultrasound is a noninvasive and cost-effective modality with no risk of radiation exposure serves as a primary imaging modality in the evaluation of perimenopausal females with menstrual complaints.
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Estimating the frequency of candida in oral squamous cell carcinoma patients Highly accessed article p. 293
Radhika Gadge, Namrata Jidewar, Alka Hande
DOI:10.4103/jdmimsu.jdmimsu_49_19  
Background : Oral squamous cell carcinoma (OSCC) is one of the most common cancers affecting the oral cavity. Worldwide, the occurrence of OSCC is estimated to be 26,000 cases annually. Material and Method: It consists of a variety of normal human flora but in an elevated form. In this study, the association between OSCC and Candida was investigated. Twenty samples from patients suffering from OSCC and 20 healthy samples were taken. Results: Both the samples were tested for the presence of Candida. Sabouraud's Dextrose Agar plates were used for a culture which was then incubated to detect the growth of Candida. Colony identification was done using Gram stain. When the growth of Candida on both the groups of samples was compared, the frequency of Candida was found to be significantly higher in patients with OSCC than the healthy individuals. Conclusion: Our results authenticated with the other studies related to OSCC and yeast carriage. More amount of yeast carriage was associated with OSCC patients.
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Comparison of intravaginal misoprostol and intramuscular carboprost for cervical priming in the first trimester of medical termination of pregnancy Highly accessed article p. 296
Sapna Sharma, M Tiwari
DOI:10.4103/jdmimsu.jdmimsu_154_19  
Background: Suction evacuation is a widely used method for elective termination of pregnancy in the first trimester. The step of mechanical cervical dilatation during this procedure is probably the most critical step. Difficult cervical dilatation may cause incomplete evacuation, cervical laceration, and uterine perforation. Prior cervical priming with pharmacological agents like prostaglandin derivatives, although not free from side effects, makes the procedure easier with reduced overall complication rate and hence recommended in several guidelines. Aim: The aim of the study was to compare, two prostaglandin derivatives, intravaginal misoprostol (15-deoxy-16-hydroxy 16-methylprostaglandin E1) with intramuscular carboprost (15-methyl prostaglandin F2α) for cervical priming prior to suction evacuation in the first-trimester termination of pregnancy. Settings and Design: A prospective study was conducted at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra. Materials and Methods: Eighty women requesting pregnancy termination from 6th to 12th week gestation were randomized into two groups. Two hours prior to suction evacuation, the first group (n = 40) received 400 μg of intravaginal misoprostol, while the second group (n = 40) received 125 μg of intramuscular injection carboprost. The outcomes of both the groups were recorded in terms of baseline cervical dilatation, immediate complications, drug-induced side effects, and patient's acceptability by questionnaire. Results: The “mean baseline cervical dilatation” prior to suction and evacuation in the misoprostol group was 8.11 ± 0.95 mm in the carboprost group was 6.25 ± 0.06 mm which is highly significant (t = 7.02, P <0.0001). The “mean baseline cervical dilatation” was more in misoprostol (Group A) than carboprost (Group B) >8 mm, compared to 17.5% in carboprost group (P = 0.004). The side effects including nausea, vomiting, and abdominal cramps were more in carboprost group as compared to the misoprostol group. No patient had diarrhea in misoprostol group as against 32.5% in carboprost group (P < 0.0001). There were no complications like incomplete evacuation, cervical lacerations, or uterine perforation noted in either group. Conclusion: Cervical priming prior to suction evacuation results in easier dilatation reducing the incidence of complications. Intravaginal misoprostol appears to be more effective with minimal side effects, hence easily acceptable alternative as compared to intramuscular carboprost.
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Evaluation of abnormal uterine bleeding patients by conventional dilatation and curettage and hysteroscopically guided dilatation and curettage Highly accessed article p. 303
Puja Kumari Radhikabai, Kiran Borkar
DOI:10.4103/jdmimsu.jdmimsu_165_19  
Introduction: Abnormal uterine bleeding (AUB) is a newly coined term for describing the condition, wherein there is any deviation from a normal menstrual pattern. It is the most often encountered gynecological problem. Dysfunctional uterine bleeding and bleeding from structural causes both are included in it. Each year approximately 10% of women aged 30–50 years consult a gynecologist for treatment. This makes it imperative to accurately diagnose and treat the cause. This study aims at judging the place of diagnostic hysteroscopy in obtaining an accurate diagnosis of the etiology of AUB and outlining a mode of treatment. This is done by correlating the findings on hysteroscopy and those found on conventional dilatation and curettage (D and C). Materials and Methods: This prospective study was performed in the Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College (DMIMS), Wardha, Maharashtra. Eighty cases of AUB were chosen based on inclusion and exclusion criteria. The patients were subjected to routine investigations, ultrasonography. Forty patients underwent conventional D and C and next 40 patients underwent hysteroscopic guided curettage with biopsy. The findings of the two were compared and analyzed. Results: AUB was the most common between 30 and 40 years…. Maximum patients had complaints for 3 months to 1 year. Menorrhagia was the most common presenting complaint. Normal findings were observed in 19 cases with conventional D and C of 40 cases and 3 cases with hysteroscopic-guided biopsy out of 40 cases. Abnormal findings were seen in 2.5% of cases of 40 cases with conventional D and C, 42.5% of cases of 40 cases with hysteroscopic guided biopsy. Conclusion: This study reveals the superior ability of hysteroscopic guided D and C with biopsy in evaluating patients with AUB when compared to conventional D and C. These findings are in agreement with those of many other studies.
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Role of laparoscopy in the diagnosis of chronic pelvic pain p. 310
Manjusha Agrawal, Sri Nayana Kolli
DOI:10.4103/jdmimsu.jdmimsu_172_19  
Introduction: Chronic pelvic pain (CPP) is noncyclic pain of 6 or more months' duration that localizes to the anatomical pelvis, anterior abdominal at or below the umbilicus, and the lumbosacral and is of sufficient severity to cause functional disability. Lower abdominal pain can be caused by chronic pelvic inflammatory disease, pelvic adhesions, certain ovarian cysts, pelvic vascular congestion, uterine fibroids, and adenomyosis, but pain arising from organs outside the pelvis may also radiate to the lower abdomen. Only 20%–25% of patients respond to conservative management. When such treatment fails, a diagnostic laparoscopy is usually performed. Aim: We aim to study the role of laparoscopy in the diagnosis of CPP. Objective: The objective was (1) to evaluate the causes of CPP by diagnostic laparoscopy and (2) to compare the clinical finding and ultrasound findings with laparoscopic findings. Materials and Methods: The present study includes fifty patients presented with lower abdominal pain of at least 6-month duration. A detailed history was taken about the pattern of the pain and its association with other problems. Gynecological examination included inspection of the vulva and perineum, speculum examination of the cervix and vagina, bimanual examination to assess the shape, size, direction, mobility of the uterus and adnexa, mass and tenderness of the urethra, vaginal fornix and cervical motion tenderness. The patients were further evaluated by ultrasound examination (transvaginal and abdominal) and diagnostic laparoscopy. Results: Most of the women were of the mean age group of 29.30 years. The pain was most commonly associated with dysmenorrhea in 76% of the patients. Nine patients out of 26 who showed normal findings on bimanual examination revealed abnormal findings on laparoscopy. Five patients out of 22 who showed normal findings on ultrasonography showed abnormal findings on laparoscopy. Conclusion: Laparoscopy is a gold standard tool in the evaluation of women with CPP because diagnosis and treatment can be done in the same sitting.
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Assessment of risk of liver fibrosis in areca nut habitual by ultrasound elastography p. 315
Suwarna Dangore-Khasbage, Rahul Bhowate
DOI:10.4103/jdmimsu.jdmimsu_227_19  
Purpose: The purpose of this study was to assess the risk of liver fibrosis in areca nut (AN) habitual by ultrasound elastography. Materials and Methods: This case–control study included sixty individuals, which were equally divided into four groups. Among these, 15 belonged to the control group, whereas 45 were chronic AN chewers either suffering from habit-induced oral disease or not suffering from habit-induced oral disease. All of them were assessed for oral health status by recording habit history and oral examination findings. Liver status was assessed by conventional ultrasonography and elastography. Results: Ultrasonography revealed the presence of liver fibrosis in 6 (10%) participants. Among these participants, 3 (50%) were suffering from oral submucous fibrosis (OSMF), 2 (33%) had OSMF with oral squamous cell carcinoma, and 2 (17%) were AN habitual only. On elastography, FibroScan values were observed to be higher in liver fibrosis-diagnosed participants though the difference between habitual and nonhabitual was not significant (NS) (P = 0.103, NS). Conclusion: On assessment of liver status, liver fibrosis was diagnosed in 10% AN habitual. This finding is alarming one and needs a specific concern as these habitual participants were totally asymptomatic and unaware of their liver status.
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The effect of music therapy in critically ill patients admitted to the intensive care unit of a tertiary care center p. 320
Anil Jawaharani, Sourya Acharya, Sunil Kumar, Aditi Gadegone, Nitin Raisinghani
DOI:10.4103/jdmimsu.jdmimsu_41_20  
Introduction: The role of music in medicine, and specifically, Intensive care medicine is still unclear; however, its role in affecting vital parameters is well known. Thus, in recent years, music has been increasingly used as a therapeutic tool in the treatment of different diseases and in intensive care medicine. Neural plasticity has been believed to explain some of the sensorimotor and cognitive enhancements that have been associated with music therapy. Thus, a study was conducted to see if it can serve as complementary method for treating perioperative stress and for acute and chronic pain management in a critical care setting. Aim and Objectives: The aim is to evaluate the effect of music therapy on clinical parameters in critically ill patients, its role in causation of biochemical parameters, and its effect on the overall outcome in critical care patients. Materials and Methods: The study was a cross-sectional study conducted in the intensive care unit (ICU) of the medicine department, AVBRH, Sawangi, from September 2018 to February 2019. The study involved 120 adult patients aged 18–85 years categorized into 60 cases and 60 controls. Reasons for hospitalizations primarily included sepsis, congestive cardiac failure, acute respiratory distress syndrome, cerebrovascular episodes with complications, and chronic kidney disease with concurrent complications. Cases were administered music therapy in the form of classical piano pieces composed by Mozart, played for 20 min in the morning, afternoon, and evening, while controls received only protocol-based management. Data were entered in Microsoft Office Excel 2010 and analyzed using the IBM SPSS software version 22.0 (Chicago, Illinois, USA). Results: Case category patients were found to have a statistically significant reduction in Glasgow Coma Scale, heart rate, blood pressure, and Hamilton anxiety scale rating on day 1 versus day 5 and in comparison to the control group as well. Case patients were also noted to have a lesser duration of hospital stay and lesser mean morbidity in the ICU compared to controls. Conclusion: Thus, authors believe that music therapy can be a crucial adjuvant to protocol-based management that already exists across critical care settings, and strongly feel that further studies, including a greater number of patients and follow-up evaluations, are needed to confirm promising results observed in this study.
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Comparison of visual outcomes and complications of scleral-fixated intraocular lens and iris-claw lens in aphakic patients p. 326
Sachin Daigavane, Vrushali Shende, Madhumita Prasad
DOI:10.4103/jdmimsu.jdmimsu_171_19  
Introduction: With newer advances and improved techniques for implantation of posterior chamber intraocular lens (IOLs) in cataract surgery, the chances of encountering aphakia have reduced significantly. There is still a need to study secondary IOLs to deal with cases involving no or weak capsular support. In such cases, anterior chamber IOLs (ACIOL), iris-claw lens (ICL), or scleral-fixated IOLs (SFIOL) may be used. Excluding ACIOLS by virtue of higher complication rates, this study was done to explore the superiority of SFIOL and ICL. Aim: The aim of the study is to compare the visual outcome and complications of posterior ICL and SFIOL. Materials and Methods: It was a prospective interventional hospital-based study on 26 patients from the ophthalmology outpatient department fulfilling inclusion and exclusion criteria. Detailed history and ophthalmological examination was done for all patients and they were divided into two groups based on iris morphology. Of 26 aphakic patients, 13 were implanted with ICL and 13 with SFIOL by a single surgeon, and visual activity and complication rates in both the groups were compared. Results: There was a statistically significant difference in visual acuity (VA) on day 1 postoperative with 6/18 vision on Snellen's chart in ICL-implanted patient and 6/60 in SFIOL-implanted patients. However, best-corrected VA on the 45th day postoperative was comparable in both the groups. Complication-wise SFIOL group showed dreadful complication like retinal detachment, whereas ICL group presented maximally with immediate postoperative iritis and ovalization of the pupil as long-term complication which was harmless. Conclusion: Both ICL and SFIOL are good choices for secondary IOL implantation. Visual outcomes of both the lens were comparable on late follow–up; however, complication-wise ICL is preferred over SFIOL.
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Role of sonography and color doppler in the evaluation of scrotal swellings p. 330
Kartheek Goje, Rajasbala Dhande
DOI:10.4103/jdmimsu.jdmimsu_166_19  
Background: Ultrasonography combined with color Doppler is the first modality for investigation of scrotal swellings. It is difficult for a clinician to differentiate a testicular pathology from an extratesticular one with presents as a scrotal swelling based on physical examination alone. Aims and Objectives: Early detection of pathology and establishing a surgical versus nonsurgical treatment for acute scrotal pain is important. Materials and Methods: This study included a total of 107 patients. Various scrotal pathologies were detected with ultrasound and Doppler with clinical correlation and found out that noninflammatory pathologies are more common than inflammatory pathologies. Conclusion: We concluded that high-resolution sonography and color Doppler can be used as a primary imaging modality in the diagnosis of scrotal pathologies.
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Relationship between intelligence and impulse control among new entrants studying in various medical disciplines p. 338
Rupali Sarode, Vaishali Tendolkar
DOI:10.4103/jdmimsu.jdmimsu_175_19  
Background: Students from various medical disciplines require above-average intelligence to understand all the medical subjects and concepts as it deals with human body and human life. Impulse control (patience) is an absolute virtue of health professional courses. Health professional students are expected to possess good impulse control. Objective of the Study: The objective was to assess the relationship between intelligence and impulse control among new entrants studying in health professional courses. Study Design: This is a correlation study. Population: First-year students, both males and females, from various medical disciplines including MBBS, BDS, BAMS, and B.Sc. Nursing constituted the study population. Sample Size: A total of 400 (50 males and 50 females from each of the four health disciplines) students were selected purposively from Nagpur and Wardha districts of Maharashtra, India. Impulse Control Scale and Culture Fair Intelligence Test were used for data collection. The results showed that impulse control and intelligence are positively correlated (male: r = 0.137,P > 0.05, and female: r = 0.22, P <0.05). For overall participants, the two variables were positively and statistically significantly related (r = 0.173, P <0.05). Conclusion: The findings revealed that the higher the intelligence, greater the impulse control for both male and female new entrants of all the four medical disciplines. Female students showed greater magnitude of positive correlation as compared to male students.
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A comparative clinical study of the precorneal tear film in diabetic and nondiabetic persons p. 342
Yash Hada, Shashank Banait
DOI:10.4103/jdmimsu.jdmimsu_176_19  
Context: The study objective was to compare precorneal tear film in terms of amount and stability in diabetic and nondiabetic individuals. Aims: The aim was to study the effect of diabetes on the amount and stability of precorneal tear film. Settings and Design: This is a hospital-based, prospective, case–controlled, observational study of 1-year duration. Sixty-five sequentially collected patients with diabetes and 65 age- and sex-matched nondiabetics, attending the ophthalmology outpatient department/inpatient department at AVBRH were selected for the study after taking the inclusion and exclusion criteria into consideration. Informed consent was taken from all participants after approval by the Institutional Ethical Committee of the college. Subjects and Methods: After enrollment of the participants to the study, all underwent a thorough ophthalmic examination. Tear film break-up time (TBUT) and Schirmer's test without anesthesia followed by with anesthesia were calculated. Statistical Analysis Used: Statistical analysis was done by using descriptive and inferential statistics using Chi-square test and Student's unpaired t-test, SPSS 17.0 version and GraphPad 6.0 version software were used in the analysis, and P <0.05 was considered as level of statistical significance (P < 0.05). Results: Patients with diabetes showed more unstable tear film as compared to nondiabetics of the same age and sex. The amount of tear film measurement also decreases in diabetics. A higher number of positive test results for both Schirmer's test and TBUT test were found in patients having duration of diabetes > 5 years. Conclusions: Longer duration of diabetes is associated with dry eye. Diabetes is associated with reduction in the amount of precorneal tear film as well as an unstable precorneal tear film.
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Association of meibomian gland dysfunction with dyslipidemia contributors p. 346
Shashank Banait, Yash Hada
DOI:10.4103/jdmimsu.jdmimsu_192_19  
Aims: To determine the association between dyslipidemia and MGD. Settings and Design: It is a prospective, observational study of 1 year duration. Thirty patients who were diagnosed with meibomian gland dysfunction and 30 age and sex matched controls were taken into study after they gave their informed consent and taking into consideration the inclusion and exclusion criteria. Methods and Material: After enrollment of the subject to the study all subjects had undergone a thorough ophthalmic examination. Tear film break up time, Schirmer's Test without anesthesia followed by with anesthesia was calculated. Statistical analysis used: Meibomian gland status was evaluated by, expressibility, and numerical scoring of staining. test was done by taking venous sample of blood in a red-topped vacutainer after overnight fasting. Values of total cholesterol (TC), high-density lipoprotein (HDL) , low-density lipoprotein (LDL), and triglycerides (TGs) were noted. Results: There exists an association between increasing stage of MGD and age and increasing values of TC,LDL,TGs of lipid profile.Conclusions: Higher stages of MGD are associated with increased age. MGD and increasing levels of LDL, total cholesterol, and triglycerides have a positive correlation.
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Impact of K-Taping on sacroiliac joint pain in women after full-term normal delivery p. 352
Shalaka Khobragade, Waqar Naqvi, Shalaka Dhankar, Shyam Jungade
DOI:10.4103/jdmimsu.jdmimsu_182_19  
Background: This study will help to plan the treatment protocol for reducing immediate sacroiliac joint pain with the help of K-tape in women after full term normal delivery and provide better quality of life to get back their activities of daily living more comfortably.Aim and Objectives: Aim of the study is to find out the impact of k-taping in sacroiliac joint pain in women after full term normal delivery. With following objectives 1) To study the impact of kinesiological taping in Sacroiliac joint pain in women after full term normal delivery. 2) To study the quality of life (QOL) in women with sacroiliac joint pain after full term normal delivery. Materials and Methods: study population: women with sacroiliac joint pain after full term normal delivery. Outcome measures- (A) Numeric pain rating scale (NPRS), (B)Roland Morris Disability Questionnaire (RMDQ). Intervention: The intervention period was of 72 hours where K-tape done in experimental group with exercise and only exercise in control group and both the outcome measures were documented. Result: Statistical analysis was done by using descriptive and inferential statistics using student's paired and unpaired t test and software used in the analysis was SPSS 22.0 version and p<0.05 is considered as level of significance. Conclusion: The study concluded that K-taping can be used as an adjunct to exercises in the treatment for solely sacroiliac joint pain reduction but we did not find K-taping as more effective treatment in improving functional disability in females after full term normal delivery with sacroiliac joint pain.
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Effect of live demonstration on practices of auxiliary nurse midwives identification and management of high-risk mothers for secondary postpartum hemorrhage during the postnatal period p. 356
Jasneet Kaur, Suresh Ray
DOI:10.4103/jdmimsu.jdmimsu_115_19  
Background: An estimated 289,000 women die each year from complications in pregnancy or childbirth with over half of these deaths occurring in sub-Saharan Africa. Millennium Development Goal 5, to improve maternal health, includes a target to reduce the maternal mortality ratio by three quarters by 2017. The identification and initial management of high-risk mother during the postnatal period totally depend on the knowledge and practices of these ground-level workers; otherwise, they will remain unnotified and unreported. Objective: The main objective of the study was to determine the effect of demonstration on practices of auxiliary nurse midwives (ANMs) identification and management of high-risk mothers for secondary postpartum hemorrhage (PPH) during the postnatal period. Materials and Methods: Quasi-experimental design was adopted to implement live demonstration on 40 ANMs. The sample was selected by convenience sampling technique. Checklist was used to assess the practices of ANM identification and management of high-risk mothers for secondary PPH during the postnatal period. Results: Average practices score in pretest was 73 which increased to 138.8 in posttest. T-value for this test was 36.7 with 13° of freedom. Corresponding P value was small (<0.05), null hypothesis is rejected. It is evident that the live demonstration is significantly effective in improving the practices of ANMs regarding the identification and management of high-risk mothers during the postnatal period for PPH in the experimental group. Conclusion: It is evident that the live demonstration is significantly effective in improving the practices of ANMs regarding the identification and management of high-risk mothers during the postnatal period for PPH in the experimental group.
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A morphological and morphometric study of distal end of ulna with its clinical implications p. 360
Chandni Gupta, S Naik, Punnose Kurian, Sneha Kalthur, Vikram Palimar, Antony D'Souza
DOI:10.4103/jdmimsu.jdmimsu_38_18  
Background and Aim: The distal end of the ulna is of utmost anatomical importance for normal hand functioning. It can get damaged in various injuries such as avulsion of the ulnar styloid process or ulnar styloid triquetral impaction syndrome. Hence, the aim of this study is to measure the various dimensions of distal end of ulna and to look for its various morphological features. Materials and Methods: The study was conducted on fifty dry ulnae of unknown sex. Length of styloid process, width of fovea, and pole and height of seat were measured. Various morphological features of the distal end of ulna were also noted down. Results: The mean length of styloid process, width of fovea, and pole were 0.55, 0.47, and 0.56 cm, respectively. The mean height of seat was 0.72 cm. In 59.57% of cases, the styloid process was straight and in 78.7% of cases, the tip of the styloid process was blunt. The most common shape of pole was kidney shape in 48% of cases. Conclusion: The results of this study will be useful for hand surgeons in dealing with distal ulnar injuries and even for reconstruction of the distal radioulnar joint with prosthesis of distal end of ulna.
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Cadaveric dissection and changing perceptions in learning anatomy p. 365
Manah Changmai, Kastury Gohain
DOI:10.4103/jdmimsu.jdmimsu_49_18  
Background: An insight of human anatomy is achieved by imparting knowledge through different models and cadavers. Students experience the reality of the human body through dissection. The present study is conducted to know the perception and importance of cadaveric dissection among students in learning anatomy. Methodology: A total of 115 students participated in this study. A closed-structured questionnaire was used to collect the data from the 1st year Bachelor of Medicine and Bachelor of Surgery students in the International Medical School, Management and Science University, Shah Alam, Malaysia. A descriptive analysis was performed to determine the mean, frequency, and variance. The percentages of the calculated variable were measured by ANOVA, and the significance level is compared with Fisher's test. The analysis of the collected data was performed using SPSS version 23 with a statistical significance of P < 0.05. Results: The results indicated no gender difference in opinions concerning dissection between majority of students. However, there is a belief among students that demonstrations of specimen are equally important as performing dissection. Conclusion: The breakthrough in technology in teaching–learning methodology in medicine diversified the student's perception in learning anatomy. The final result demonstrated conflicting opinion between students agreeing dissection as the only catalyst to learn anatomy.
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Effectiveness of video-assisted teaching program on toilet training of toddlers among parents in a selected rural area in Shimla, Himachal Pradesh, India p. 370
Jinu Rajan
DOI:10.4103/jdmimsu.jdmimsu_83_18  
Introduction: Family is the central focus in the life of toddlers. A toddler in turn exerts considerable influence on all the other family members, regardless of the size and form of the family unit. As toddlers begin to interact with others outside the family, the parents help the child to conform to the expectations of the society. The most important societal demand made on the child during this period is the control of elimination. Materials and Methods: In order to achieve the objectives of the study, a preexperimental study approach was adopted for the study. The conceptual framework used for the study was based on General System Theory. A close-ended questionnaire was used to assess the knowledge of parents on toilet training. A pilot study was conducted in an anganwadi, situated in Shimla, Himachal Pradesh, India, and there were no major problems encountered while conducting the study. Purposive sampling technique was used to select the sample. The sample consisted of forty parents of toddlers. The main study was conducted in an anganwadi, situated in Shimla area. The data collected were systematically tabulated to facilitate the data analysis. The collected data were analyzed by using descriptive and inferential statistics. Results: The analysis of the demographic variables revealed that majority (40%) of the participants are in the age group of 26–30 years. Among the participants, most (52.5%) of them completed high school education. The highest percentages (90%) of the samples were females. Majority of the participants (80%) are Hindus and 20% are Muslims. Most of them (57.5%) were having two children and 67.5% of them have their second child as toddler. A majority (77.5%) are homemakers. Most of them (67.5%) are living in joint families. Majority (37.5%) of the participants' monthly income is between 4001 and 6000. All the participants received information regarding toilet training, and among them, 40% got information from elders, relatives, or friends. The assessment of the knowledge among parents on toilet training revealed that majority (60%) of the parents had moderate knowledge, 35% had poor knowledge, and 5% had good knowledge. None of the participants had very good knowledge. The overall mean knowledge score was 14.03 ± 2.665, with a mean percentage of 46.75%, revealing that the overall knowledge of the parents regarding toilet training is moderate. Area-wise analysis of knowledge score revealed that the parents had the highest knowledge in the area of meaning of toilet training and its readiness with a mean percentage of 57% and least in the area of steps of toilet training with a mean percentage of 41.43%. The assessment of the effectiveness of video-assisted teaching program on toilet training revealed that the total mean knowledge score is increased by 25.83% with a mean ± standard deviation (SD) of 7.75 ± 2.55 after the administration of video-assisted teaching program. The pretest mean was 14.03 with that of SD ± 2.665 and posttest mean was 21.78 with that of SD ± 2.616. The pretest knowledge level was average in 60%, poor in 35%, and good in 2% and posttest knowledge level was very good in 12.5%, good in 70.5%, and average in 12.5% of the parents. The cumulative frequency distribution of pre- and post-test knowledge scores shown in the Ogives shows a significant difference between the pre- and post-test scores. The knowledge pretest median was 13.50, whereas the posttest median score was 21.50. It shows a difference of 9 in knowledge. Association between pretest knowledge with demographic variables revealed that there was a significant association between the preexisting knowledge with these demographic variables on toilet training. Conclusion: Experts suggest that it is easier to train a child on toileting skills when he/she is at least 18 months old, and for boys, it is better to wait even longer because they usually lack the necessary language and fine motor skills. This time frame is much easier to use because of the child wanting to please his/her parents.
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The assessment of expression of midkine in epithelial dysplasia and oral squamous cell carcinoma p. 378
Sadaf Alvi, Alka Hande, Minal Chaudhary, Madhuri Gawande, Swati Patil, Preethi Sharma
DOI:10.4103/jdmimsu.jdmimsu_178_19  
Background: Oral squamous cell carcinoma (OSCC) is categorized by a cancerous tissue growth of the epithelial cells of the oral cavity and is brought about by an array of genomic abnormalities. The survival rate of OSCC has remained nearly unchanged. For this reason, the identification of new molecules that could serve as targets for antineoplastic therapies is of prime importance. Midkine (MK) is considered to be a novel marker for determining prognosis and in early detection of cancer. Our study aims at assessing the expression of MK in oral epithelial dysplasia and OSCC. It is also an attempt to find correlation between the expression of MK and 3-year postoperative survival of patients with OSCC. Materials and Methods: The study included fifty histopathologically diagnosed cases of OSCC of various grades and fifty histopathologically diagnosed cases of epithelial dysplasia from the archives of the department of oral pathology and microbiology. These 100 samples were retrieved from a period of 3 years, i.e. 2009 to 2012. Results: Out of fifty patients with epithelial dysplasia, 47 (94%) patients showed negative expression for MK and only 3 (6%) patients showed positive expression for MK. The percentage of MK expression was PDSCC (100%), MDSCC (93%), and (76%) WDSCC showed positive expression of MK. As the Broder's grading progresses, from well to moderate to poor, the expression of MK also increased. Conclusion: According to our results, it shows that MK should be considered a target for the treatment of OSCC.
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Utility of aVR electrocardiogram lead for identifying the culprit lesion in patient with acute coronary syndrome p. 383
Virendra Patil, Kaustubh Pandere, Shoumita Damle, Aniket Avhad
DOI:10.4103/jdmimsu.jdmimsu_106_19  
Background: The lead aVR is neglected electrocardiography (ECG) lead while interpreting various cardiac diseases including coronary artery disease (CAD). The aVR lead is a potentially useful tool in ECG in diagnosing and managing patients with CAD. Aim and Objectives: The aim is to study the usefulness of ECG in localizing the culprit vessel by coronary angiogram (CAG) in patients with the acute coronary syndrome (ACS) and to find the relation of ECG findings, with regional wall motion abnormality (RWMA) and CAG profile. \Materials and Methods: This was a cross-sectional observational study done on patients admitted with the diagnosis of ACS. A total of 54 patients were included in this study satisfying the inclusion criteria presented with ACS. Results: A total of 54 patients (males: 55.7% and females: 46.3%) were enrolled fulfilling inclusion criteria of the study (male: 59.72 [±10.59], female: 55.24 [±11.93]). A total 59.36% of patients had resulting RWMA. About 33.33% of patients had single-vessel disease, 24.07% had double-vessel disease , and 18.52% had triple-vessel disease (TVD) with P = 0.081. A total 79.62% of patients ECG could able to diagnose CAD. About 100% of patients with proximal left anterior descending (LAD) lesion 85.71% with LMCA, 40% with TVD had ST elevation in aVR lead. About 66.67% of patients with the right coronary artery (RCA) and 50% with left circumflex infarction (LCx) lesion had ST depression in aVR lead. About 59.36% had RWMA on echocardiogram. Conclusions: The presence of ST elevation in aVR indicates a culprit lesion in the proximal segment of LAD or LMCA. The absence ST elevation in aVR excludes the left main coronary artery as the underlying cause in the context of anterior wall ST-elevation myocardial infarction (STEMI). ST elevation in aVR is valuable for distinguishing proximal from distal lesions in the LAD in anterior wall STEMI. ST-segment depression in lead aVR is valuable for differentiating RCA from those with LCx in the inferior STEMI. Echocardiography findings aid triage for the management of the patient with ACS.
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LETTERS TO EDITOR Top

Subcutaneous cysticercosis: Imaging findings on sonography and elastography p. 391
Varun Singh, Suresh Phatak, Samida Samad, Gulam Marfani
DOI:10.4103/jdmimsu.jdmimsu_197_19  
Cysticercosis is a disease caused by cysticercus cellulosae, a larval form of tapeworm, Taenia solium. A 35-year-old male presented with seizures and multiple subcutaneous nodules all over his body, which was diagnosed to be a case of disseminated neurocysticercosis on ultrasonography and was confirmed on brain magnetic resonance imaging. High-resolution sonography and elastography findings are discussed.
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CASE REPORTS Top

A case of fracture shaft femur in a patient with transtibial amputation p. 394
Shalaka Dhankar, Ashish Bele
DOI:10.4103/jdmimsu.jdmimsu_190_19  
Transtibial amputation refers to the removal of the ankle joint and lower leg up to distal tibia and fibula. A 45-year-male came to physiotherapy department postoperatively after mid-shaft fracture femur with a history of below-knee amputation of the same extremity presenting with knee flexion deformity, fear of fall, and difficulty in ambulation. Patient underwent extensive physiotherapy to reduce the flexion deformity by improving flexibility of hamstring, after which the patient was subjected to gait training for re-educating the patient to use his prosthetic limb.
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Mucormycosis of maxillary sinus in a newly diagnosed case of diabetes mellitus p. 397
Pawan Hingnikar, Nitin Bhola, Anendd Jadhav, Akhil Sharma
DOI:10.4103/jdmimsu.jdmimsu_170_19  
Rhinocerebral mucormycosis is the third most common fungal infection after aspergillosis and candidiasis. The importance of mucormycosis has grown in recent years, as the number of patients has increased dramatically. Herein, we present a case of a newly diagnosed patient of diabetes mellitus having ulcerated palate and destruction of maxillary sinus evident on computed tomography scan. A biopsy report was suggestive of mucormycosis. Aggressive medical and surgical treatment was done along with the treatment of diabetes mellitus.
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Surgical technique in the management of congenital unilateral syngnathia: A case report of a 4-year-old female p. 401
Rooshay Trivedi, Nitin Bhola, Anendd Jadhav, Prafulla Gaikwad, Chirag Patil, Akhil Sharma
DOI:10.4103/jdmimsu.jdmimsu_152_19  
Congenital disorders involving orofacial region represent approximately 20% of all birth defects. Syngnathia is an extremely rare condition involving congenital fusion of the maxilla with the mandible. Usually, syngnathia is associated with other anomalies and syndromes. This case report presents a novel surgical technique in the management of unilateral fusion of maxilla and mandible.
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An unusual traumatic superolateral dislocation of mandibular condyle with right parasymphysis mandibular fracture: A report of rarity p. 405
Akhil Sharma, Anendd Jadhav, Nitin Bhola, Chirag Patil, Rooshay Trivedi
DOI:10.4103/jdmimsu.jdmimsu_151_19  
We describe what is to our knowledge that anteromedial fracture dislocation of the mandibular condyle is common, but a superolateral dislocation of the mandibular condyle is quite rare, this type of dislocation is often misdiagnosed or completely overlooked and hence inadequately addressed. We report a case of a 35-year-old male patient in which there was a sagittal fracture of the right condyle and the lateral fragment was hooked on the zygomatic arch with contralateral superolateral dislocation of the left condyle and right parasymphysis fracture following a road traffic accident. The present report exhibits an atypical case and highlights its management.
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Coexistence of darier's disease and porokeratosis: A rare presentation p. 410
Palak Kedia, Bhushan Madke, Sandeep Kulkarni, Adarshlata Singh
DOI:10.4103/jdmimsu.jdmimsu_100_19  
Darier's disease and porokeratosis are both autosomal dominant genodermatosis characterized by disorder of keratinization. Hereby, we report a case of co-existing Darier's disease and Porokeratosis in an elderly male.
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Recurrent hemosuccus pancreaticus treated by endovascular intervention alone: A rare case report p. 414
Tarachand Kamble, Ayan Husain, Akshay Dafal
DOI:10.4103/jdmimsu.jdmimsu_185_19  
Hemosuccus pancreaticus is a complication of chronic pancreatitis due to the formation of pseudoaneurysms and resultant bleeding from these aneurysms into the pancreatic duct. There are few case reports in various medical and surgical journals on recurrent hemosuccus pancreaticus being treated initially by endovascular treatment followed by the surgery. Here, we report the case of a 37-year-old male who presented with recurrent hemosuccus pancreaticus and was successfully treated with endovascular intervention alone. This report highlights that such patients should be managed with endovascular intervention apart from the surgery.
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Ectopic pleomorphic adenoma in intramuscular plane of sternocleidomastoid muscle: A rare case report p. 417
Yeshwant Lamture, Aditya Ghunage
DOI:10.4103/jdmimsu.jdmimsu_89_19  
Pleomorphic adenoma is the most common salivary parotid gland tumor. It is a benign tumor, represents 45% of parotid gland tumors, and 6.5% are found in the minor salivary glands. Only five cases of ectopic mixed salivary gland tumors in the upper neck in adult patients have been reported. The present case had an ectopic pleomorphic adenoma in intramuscular plane of sternocleidomastoid muscle. Ultrasound and fine-needle aspiration biopsy revealed swelling to be pleomorphic adenoma. Intraoperatively, the swelling was not arising from the parotid gland. Although pleomorphic adenoma arising from heterotropic salivary gland tissue is rare. Pleomorphic adenoma is the most common type of salivary gland tumor. Salivary gland tumor rarely occurs in ectopic sites. Good clinical acumen along with proper diagnostic techniques is required in the diagnosis of such cases.
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Lafora body disease: A case of progressive myoclonic epilepsy in an adolescent male p. 420
Sushma Ramraje, Sameer Ansari, Ankita Nayak, Grace Costa
DOI:10.4103/jdmimsu.jdmimsu_69_18  
Progressive myoclonic epilepsy is defined as a neurological disorder manifesting classically as a trio of progressive myoclonic seizures, cognitive impairment, ataxia, and/or any other neurologic defects. Syndromic association is seen specifically with Unverricht–Lundborg disease, myoclonic epilepsy with ragged red fibers, neuronal ceroid lipofuscinoses, Lafora body disease (LBD), and sialidoses. LBD is characterized by an autosomal recessive inheritance. Adolescent-onset progressive myoclonic epilepsy is seen along with Lafora bodies in the brain, liver, and the ducts of the sweat glands in skin. We hereby present a case of a 17-year-old male, presenting with progressing myoclonus and Lafora bodies in axillary skin biopsy, thereby confirming the diagnosis of LBD.
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Radiation caries in a nasopharyngeal carcinoma patient p. 423
Shishir Shetty, Sesha Reddy, Hossam Abdelmagyd, Sura Ali Al-Bayati, Walid El-Sayed, Ahmed Shon
DOI:10.4103/jdmimsu.jdmimsu_90_19  
Radiotherapy (RT) is an important modality in the management of malignancies of the head and neck region. Like any other modality, RT has certain undesirable effects on the oro-facial structures. Radiation caries is one of the undesirable effects of radiation. To highlight the classical presentation, we are presenting a case of radiation caries in a 37-year-old male patient who had undergone radiotherapy for nasopharyngeal carcinoma.
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Treacher collins syndrome: A rare case report p. 426
SR Ashwinirani, Rutuja Sancheti, Srigiri Surath, Girish Suragimath
DOI:10.4103/jdmimsu.jdmimsu_110_19  
Treacher Collins syndrome (TCS) is a congenital disorder of craniofacial development characterized by numerous developmental anomalies confined to head and face. The jaws, ears, and eyes are commonly affected causing respiratory, hearing, and visual disturbances. This report represents a case report of TCS in an 11-year-old male patient.
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Ultrasound and color doppler features of transitional cell carcinoma of the endometrium with pathological correlation p. 429
Prerna Patwa, Suresh Phatak, Suhasini Pattabiraman, Gulam Marfani
DOI:10.4103/jdmimsu.jdmimsu_198_19  
Endometrial carcinoma is the second most common cancer of the female genital tract after cervical cancer which is still the leading cause of morbidity and mortality in developing countries. The endometrium of the uterus is usually thickened and the mass of the tissue is what forms the tumor growth. Diagnosis of endometrial malignancy involves invasive techniques which include endometrial biopsy as the standard diagnostic tool, although an initial ultrasound examination is one of the first modalities of investigations performed. We present an interesting case of transitional cell carcinoma of the endometrium in a 62-year-old postmenopausal female who presented with abnormal uterine bleeding. Grayscale ultrasound and color Doppler imaging is discussed.
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LETTERS TO EDITOR Top

Occult papillary thyroid carcinoma with pleural effusion – A rare presentation p. 432
Ajay Verma, Arpita Singh, Ved Prakash, Surya Kant, Ambarish Joshi
DOI:10.4103/jdmimsu.jdmimsu_27_18  
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Penile filariasis: Ultrasonographic evaluation p. 434
Apoorvi Shah, Suresh Phatak, Kaustubh Madurwar, Gulam Marfani
DOI:10.4103/jdmimsu.jdmimsu_205_19  
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Live ectopic pregnancy: Ultrasound and color doppler imaging p. 436
Soumya Jain, Suresh Phatak
DOI:10.4103/jdmimsu.jdmimsu_31_20  
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Ring of fire sign in cervical ectopic pregnancy p. 438
Amruta Varma, Suresh Phatak, Soumya Jain
DOI:10.4103/jdmimsu.jdmimsu_12_20  
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Portal hypertension – Paraumbilical vein collaterals causing a medusa head appearance p. 440
Megha Manoj, Suresh Phatak, Priya Lohchab, Gulam Marfani
DOI:10.4103/jdmimsu.jdmimsu_188_19  
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“White/black bars to cover eyes,” standard biomedical ethics, patient's privacy, and consent for publication p. 442
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/jdmimsu.jdmimsu_104_19  
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Case-based learning: Our experience in clinical pharmacology teaching p. 443
Ameya Hasamnis, Aditya Arya, Sapna Patil
DOI:10.4103/jdmimsu.jdmimsu_68_18  
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