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   Table of Contents - Current issue
January-March 2020
Volume 16 | Issue 1
Page Nos. 1-39

Online since Tuesday, July 7, 2020

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Sulfur-containing amino acids and oxidative stress in chronic pancreatitis patients Highly accessed article p. 1
Banavara Narasimhamurthy Girish, Rajesh Gopalakrishna, Kannan Vaidyanathan
Background: Chronic pancreatitis (CP) patients are at high risk of malnutrition due to malabsorption. Sulfur amino acids (SAAs) being important antioxidant could affect pancreatic function. In this study, we have analyzed blood SAAs and its relation to antioxidant levels. Methods: One hundred and seventy-five CP patients and 113 healthy normal controls were prospectively studied. Disease characteristics and imaging features were recorded. Plasma SAAs were estimated using high-performance liquid chromatography. Erythrocyte reduced glutathione (GSH), GSH peroxidase, superoxide dismutase, plasma Vitamin C, erythrocyte thiobarbituric acid reactive substance (TBARS), urinary inorganic sulfate, and creatinine were estimated by spectrophotometry. Results: Plasma SAAs, urinary inorganic sulfate/creatinine ratio, and blood antioxidant levels were lower, whereas TBARS was higher in CP patients as compared to controls. Plasma methionine and TBARS were inversely correlated, whereas plasma cysteine and GSH level were directly correlated. Plasma cysteine and Vitamin C levels were lower, whereas TBARS was higher in CP patients with atrophy as compared to patients without atrophy. No statistical difference in these parameters between diabetic and nondiabetic CP patients was observed. Conclusion: Deficiency of SAAs appears to be associated with oxidative stress in CP patients. Possible benefit of supplementation of SAAs needs to be elucidated.
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Integration of yoga in the management of patients undergoing surgery for Prostate Cancer: A pilot study p. 6
Deepak Chandran Nair, Abhishek Laddha, Appu Thomas, Greeshma C Ravindran, Ginil Kumar Pooleri
Introduction: Integration of yoga in health-care management has beneficial effects in the management of many health-related issues with improved outcomes with no added cost. We conducted a pilot study to study the feasibility of yoga in the integrated management of patients with localized prostate cancer undergoing robotic-assisted radical prostatectomy. Methods: This prospective pilot study included twenty patients who underwent robotic-assisted radical prostatectomy between June 2019 and November 2019. The overall effects of yoga on health-related quality of life, recovery of urinary continence, and erectile function were the primary endpoints of our study. Results: Patients in the yoga group had significantly better continence rates at 1 month (90% vs. 50%) with better functional outcomes as compared to the control group at 1-month follow-up. The difference in sexual recovery was not significant in each group at 1-month follow-up.Conclusion: Yoga can be safely integrated in the postoperative management of patients undergoing radical prostatectomy with no short-term adverse side effects on overall outcomes.
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Clinical profile of road traffic accident victims p. 9
Amrutha Valsalan, TP Sreekrishnan, B Sabarish, BS Dhanasekaran, KP Gireeshkumar
Background: India is a country with very high mortality rates due to road traffic accidents (RTAs). Two-wheelers are the most common vehicle involved in the RTAs. This study aimed to describe the overall characteristics of RTAs. Objective: The objective was to study the clinical profile of trauma patients presenting to the emergency department of a tertiary care center. Methodology: A total of 200 patients were enrolled in the study. A preorganized datasheet was prepared for each patient attending the Emergency Department of Amrita Institute of Medical Sciences. It contains data about sociodemographics, trauma data, clinical evaluation result, as well as treatment strategies. Results: Most (31%) of the patients were aged between 20 and 30 years. The mean age of the patients was 35.8 years. There were 156 males (78%) and 44 females (22%). More than half of the patients were from urban areas. Most patients (82%) were injured by two-wheelers. Sixteen patients did not wear helmet, in which eight patients (50%) had a head injury. Conclusion: Trauma is a major health problem, especially in the young population in our country. Two-wheelers are the most common vehicle involved in the RTAs. Trauma is the leading cause of morbidity and mortality among all age groups, and injuries from RTA is the most common cause of disability in the developing world.
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Perceptions regarding dentist persona in the Indian population p. 13
Chaitali Hambire, Umesh Hambire
Background: India is a country with multiracial societies having diversity in culture. This can have a significant role in influencing patient's perception related to appearance, ethnicity, quality of dental care, and verbal and nonverbal communication of dentists. This research principally focused on the assessment of patient's perceptions with regard to dentist's demeanor and its role in nonverbal communication which, in turn, will affect their future dentist–patient relationship. Aims and Objective: To assess attitude of children and adults toward's the physical attributes of dentist and its association with reliability, comfortability and anxiety.Materials and Methods: 600 children and 1500 adults participated in a cross sectional observational study to assess the perception of patients regarding the physical characteristics of dentist. A set of questionnaire dealing with the physical attribute was designed in English, local (Marathi) and national language (Hindi). The participants were also asked to assess the reliability, comfortability and their anxiety level based on the persona of the dentist. Results: Results of the study showed that male dentist with short hair, clean shaven and fair complexion was most desirable. Male dentist with dark complexion, stubble and bald was least preferred. Female dentist having fair complexion wearing light makeup, jewellery with hair tied neatly was found to be most desirable. Dark complexion female wearing heavy makeup and jewellery with coloured hair was found to be least desirable. Conclusion: These results will help in developing a proper professional dentist persona for effective and efficient patient management. Limitations of the study are considered.
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Profile of drug-induced liver injury due to antibiotics in patients with chronic liver disease p. 20
CM Neethu, Rajesh Gopalakrishna
Background: Patients with chronic liver disease (CLD) may be more susceptible to drug-induced liver injury (DILI) through reduced drug clearance, aberrant metabolism, altered excretion, or impaired adaptive responses. The diagnosis of DILI may identify a reversible cause for acute decompensation. Aim: The aim was to study the profile and outcomes of DILI in CLD patients. Patients and Methods: A total of 400 consecutive in patients with CLD who had been received antibiotic therapy between September 2015 and April 2016 were prospectively studied for features suggestive of DILI. The Naranjo Adverse Drug Reaction (ADR) Probability Scale was used for identifying ADRs in CLD patients. Results: Sixty-three (15.8%) patients were identified by Naranjo Scale. The most common etiology of CLD in these patients was alcohol (49.2%); hepatitis C virus (7.9%), NASH (4.3%), cryptogenic (14.3%), and hepatitis B virus (5.6%) were other common causes. DILI was more common in Child class C (52.4%) as compared to Child B (30.2%) and Child A (17.4%). Thirteen (20.6%) patients had hepatitic, 17 (27%) had cholestatic, and 33 (52.45) had a mixed pattern. There were six cases with DILI due to anti-tubercular treatment. Clarithromycin (9 cases), clindamycin (9 cases), amoxicillin-clavulanate (7 cases), and co-trimoxazole (5 cases) were the most common antibiotics causing DILI in CLD patients. Forty-three (68.2%) recovered, 11 (17.4%) expired, 3 (4.7%) developed acute on chronic liver failure, and 2 (3.1%) underwent liver transplant. Conclusions: Definitive diagnosis of DILI in CLD patients is difficult, and it is often a diagnosis of exclusion. Exposure to a potentially hepatotoxic agent, the temporal profile of liver function test changes after initiation and withdrawal of antibiotics is useful pointers. Early diagnosis of DILI, even if not definitive, may help in timely intervention and affect outcomes in CLD patients.
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Assessment of effectiveness of integrated teaching in oral radiology among dental students: A comparative study p. 23
Aarya H Nair, Beena Varma, Renju Jose, MS Aravind, Nitin Anand Krishnan
Background: Basic science subjects are usually taught during the first and second academic years of the Undergraduate training with minimum or no integration with the clinical subjects, thereby creating a compartmentalization within the curriculum. The students have difficulty in understanding the concepts and depend on their ability to memorize facts for diagnosing various disease conditions. Aims and Objectives: To evaluate and compare the Effectiveness of Integrated teaching on diagnostic accuracy in Oral radiology among dental students. Material and Methods: A total of 46 students were randomly divided into 2 groups – Integrated basic science group (BSG) and segregated group (SG). Learning materials included sets of intraoral periapical radiographs and lecture based classes on radiographic features of a normal tooth, periapical abscess, periapical granuloma and periapical cyst. BSG students were taught regarding the radiographic appearance and the cause for such appearance in the radiograph. SG students were only explained regarding the radiographic features of these entities. Following the discourse, two tests - Diagnostic test (multiple-choice questions) on the day of lecture, followed by a memory test (spot diagnosis and match the following) one week later - were done to assess the level of understanding among the students. Statistical analysis was done using Students's t – test. Results: BSG students outperformed both in diagnostic test and memory test when compared to SG students. Conclusions: Integrated teaching has been found to be an effective method in enhancing diagnostic accuracy in Oral radiology and also improving the ability to memorize concepts among dental students.
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A rare case of disseminated histoplasmosis with oral manifestations in a rheumatoid arthritis patient treated with rituximab: Diagnostic and management challenges – A review p. 27
Shruti Bajad, JN Durgarao Yadavalli, Dhaval Tanna, Gayatri Ekbote, Wasim Kazi, Rajiva Gupta
Disseminated histoplasmosis happens to be a rare complication that rheumatologists come across in their clinical practice. Biologics, mainly tumor necrosis factor blockers, have been mentioned as one of the causative factors in invasive histoplasmosis, and there are few case reports to support that. However, rituximab use has not been reported with histoplasmosis infection frequently. The association of such novel biologic agents with serious infections such as histoplasmosis needs further exploration as timely management and intervention can be life-saving for the patient. We report about a 69-year-old female, diagnosed with rheumatoid arthritis, who was treated with rituximab and subsequently developed disseminated histoplasmosis. She was successfully managed with antifungals. Here, we discuss the latest evidence-based treatment modalities for such patients with special reference to rheumatoid patients on biologic therapy.
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A surgical surprise reviewed – subcutaneous phaeohyphomycotic cyst p. 30
Naveen Sivadas, Riju Ramachandran, Anoop Vasudevan Pillai, Anjali Krishnan
A 65-year-old female patient presented to the general surgery outpatient department with a nodule in the left palm for 3 months. She gave a history of having pricked her left hand while preparing a composite by crushing dried leaves in her farm. Clinical examination revealed a tender 1 cm × 1 cm hemispherical swelling with well-defined margin in the palm of the left hand which was firm in consistency. There was no foreign body or signs of inflammation. A clinical diagnosis of implantation dermoid cyst was made. The swelling was excised and sent for histopathological examination. Histopathology showed palisaded granuloma with suppuration and cyst formation, with vegetable matter and occasional fungal hyphae resembling a phaeohyphomycotic cyst. A surgically treatable fungal disease may be a differential diagnosis for a swelling in the hands and feet, especially in population exposed to these pathogens.
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Metastatic lung adenocarcinoma presenting with isolated abducens palsy: Case report and literature review p. 33
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
Almost half of the individuals with lung cancer will develop central nervous system metastases during the course of their disease. We report a case of an adult female presenting with progressive horizontal diplopia. Neurological examination showed horizontal diplopia in all directions of gaze. Eye movements were disconjugate when looking to the left; there was no abduction of the left eye. Bilateral vertical eye movements and right horizontal eye movements were intact. A cranial computed tomography (CT) scan revealed multiple lesions in both brain hemispheres suggestive of metastasis. An investigation to search suspected neoplasia of unknown origin was started. Chest CT scan with contrast revealed a large lesion, which was localized in the upper right lobe. An abdominal CT scan showed multiple lesions in the liver. A liver biopsy and the immunohistochemistry were diagnostic of adenocarcinoma of the lung. Three months after, the patient died due to septic shock following pneumonia.
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Effective containment of the Plague outbreak in Madagascar p. 36
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
Plague is an infectious and a zoonotic disease which predominantly shows its existence in areas with poor sanitary conditions. Madagascar has reported multiple outbreaks in the recent past, including the ongoing outbreak in 2018. Acknowledging the fact that the disease is preventable and often associated with fear in the community, there is a significant and an indispensable need for the public health authorities to plan and implement targeted strategies, which not only plays an instrumental role in reducing the caseload, but also the disease-specific mortality. However, the ground reality is that none of the proposed measures can deliver sustainable results if we don't support these initiatives with financial assistance. To conclude, the need of the hour is to adopt a multi-sectoral and a multifaceted approach to ensure that the ongoing outbreak is effectively contained. However, there are no doubts that the success of the same will be eventually determined by the quality of outreach services and availability of the essential logistics.
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Population outreach program in controlling COVID-19 through social media p. 38
Syed Sadat Ali
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