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   Table of Contents - Current issue
January-March 2019
Volume 9 | Issue 1
Page Nos. 1-65

Online since Friday, February 15, 2019

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Prucalopride: A recently approved drug by the food and drug administration for chronic idiopathic constipation Highly accessed article p. 1
Rajiv Mahajan
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Posttrial access to medical interventions: Intricacies, challenges, and solutions p. 3
Harmanjit Singh, Sunil Vishwas Rao, Ashish Kumar Kakkar, Jagjit Singh, Hasitha Diana Manohar
With the recent increase in clinical trials, lower- and middle-income countries are preferred trial sites due to lower budgets and easy availability of potential participants. On trial completion, benefits to participants cease and it may affect their health adversely. Therefore, entitlement to posttrial access (PTA) of interventions is imperative. The Declaration of Helsinki and several other guidelines mandate that trial participants have access to experimentally proven efficacious drugs and that the research protocol should mention PTA provision mechanisms. A controversial question about PTA is whether, experimentally proven therapy should be made accessible to the control group as well as the community from which the participants were enrolled, especially if no satisfactory standard treatment exists. PTA has significant implications for various stakeholders – trial participants, investigators, sponsors, regulatory authorities, and governments and has been discussed and well addressed in recent guidelines issued by the Indian Council of Medical research. This article focuses on the PTA, guidelines related to PTA, disputes, different stakeholder perspectives, and practical difficulties in its implementation. It also looks at PTA from the Indian perspective and considers possible solutions to deal with the controversies.
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Merkel cells: A collective review of current concepts p. 9
Jacob Abraham, Sherin Mathew
Merkel cells (MCs) constitute a very unique population of postmitotic cells scattered along the dermo-epidermal junction. These cells that have synaptic contacts with somatosensory afferents are regarded to have a pivotal role in sensory discernment. Several concerns exist till date as to their origin, multiplication, and relevance in skin biology. The article, a collective review of literature extracted from PubMed search and dermatology books, provides novel insights into the physiology of MCs and their recent advances.
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Clinical profile and outcome in patients of diabetic foot infection p. 14
Abhinav Seth, Ashok Kumar Attri, Hanish Kataria, Suman Kochhar, Sheetal Aatrai Seth, Nitesh Gautam
Purpose: The aim is to study the clinical profile and outcome of patients presenting with diabetic foot infections (DFI). Methods: This was a prospective study recruiting patients >18 years of age, with DFI. All patients underwent a detailed history and clinical examination. Patients were classified as per the International Working Group on the Diabetic Foot -IDSA classification. The patients were followed up every month for 3 months. Clinical outcome was studied regarding the rate of amputations, readmissions, and mortality. Results: There were 65 patients with a mean age of 58.49 ± 11.04 years with male predilection (83.08%). Mean duration of diabetes mellitus was 12.03 ± 6.96 years. Ulcer (92.31%) and discharge (72.31%) were the most common presenting complaints. Monomicrobial growth was present in 36 patients (55.38%). Majority of isolates were Gram-negative (71.43%). The most common isolates were Escherichia coli and Staphylococcus aureus (28.57% each). Mild, moderate, and severe DFI was present in 40%, 47.69%, and 12.31% of patients, respectively. Severe DFI was associated with poor ulcer healing (P = 0.02) and higher number of major amputations (P < 0.001). Minor amputations were most commonly associated with moderate and severe DFI. Severe DFI had the highest number of readmissions (P = 0.04). Patients undergoing minor amputations had a significant association with area of ulcer (P < 0.001). Conclusion: This study shows the predominance of monomicrobial growth and Gram-negative organisms in diabetic foot patients. With increase in the severity of DFI, there was increased rate of hospital readmissions, amputations (major and minor), and mortality. Dimensions of ulcer may have a bearing on rate of minor amputations.
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Premarital screening and genetic counseling program: Studies from an endogamous population p. 20
Abdulbari Bener, Mariam Al-Mulla, Angus Clarke
Background: Studies in Arab countries have shown a significant lack of knowledge of Premarital Screening and Genetic Counseling (PMSGC) Program. PMSGC can identify and modify, through prevention and management, some behavioral, medical, and other health risk factors known to impact pregnancy outcomes. Objective: The aim of this study was to explore the knowledge, attitudes, and practice of Qatari's toward the premarital screening program and shedding more light on a complex matter. Materials and Methods: A cross-sectional study based on Hospitals and Primary Health Care Centers. A total sample of 1246 participants was surveyed, and 873 participants (70.0%) expressed their consent to participate in the study during January 2013–May 2014. The questionnaire based on sociodemographic data and for responses, on the PMSGC program knowledge, attitude, and practice statements. In addition, questions were asked regarding the services, activities, and how to attract and motivate the PMSGC program. Results: The mean age and standard deviation (SD) of the males' age were 30.4 ± 6.50 and the mean and SD of females' age were 31.08 ± 5.98. There were statistically significant differences between males and females with regard to age, educational status, occupation status, household income, consanguinity, body mass index, cigarette smoking, and Shisha smoking. There were no any statistically significant differences between males and females regarding sickle cell anemia and thalassemia, glucose-6-phosphate dehydrogenase deficiency cystic fibrosis, homocystinuria, HIV, and hepatitis. The response to the ''Why proceeding through high-risk marriage?'' by gender, males and females responded statistically significant differences (P = 0.019). The step-wise multivariate regression analyses as predictors for knowledge of PMSGC program revealed that age, educational level, the lack knowledge of genetics counseling, parental interventions for cousin marriage decision, positive test results affect and change marriage decision, religious impact, household income, consanguinity, hereditary diseases knowledge, occupational status, and love factors were considered as the main factors associated with the premarriage screening and genetics counseling after adjusting for age, gender, and other variables. Conclusion: The current study revealed that knowledge and attitude regarding PMSGC program were low in population. Motivation, enforcement, and implementation of program at the school and university educational campaigns are vital. Improved counseling and adding new topics for counseling on genetic, chronic, and mental illness; building healthy families; and reproduction and fertility are considered to be top priorities in community.
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Protein 53, B-Cell Lymphoma-2, Cyclooxygenase-2, and CD105 reactivity in keratocystic odontogenic tumors: An immunohistochemical analysis p. 27
Ravi Nimmanagoti, S R K Nandan, Pavan G Kulkarni, Shyam Prasad Reddy, M Keerthi, Gouri Pupala
Objective: The objective is to evaluate and compare immunohistochemically, the biological behavior of keratocystic odontogenic tumor (KCOT) with normal oral mucosa by analyzing cell proliferation, angiogenesis, and antiapoptosis using cyclooxygenase-2 (COX-2), protein 53 (p53), B-cell lymphoma-2 (Bcl-2), and CD105 (endoglin). Materials and Methods: The present study comprised 30 cases of KCOT in the study group, in which the expression of COX-2, p53, Bcl-2, and CD105 were analyzed and compared with that of control group consisting of 30 normal oral mucosae. Results: The results were evaluated based on a number of positively stained cells; among 30 samples of KCOT, 22 samples were p53 positive, 23 samples were Bcl-2 positive, 18 samples were COX-2 positive, whereas all the above markers were negative in all the 30 samples of the normal oral mucosa and CD105 mean vascular density in KCOT 13.8 in normal oral mucosa. Conclusion: The present study suggests that angiogenesis, cell proliferation, and antiapoptosis may be the possible factors contributing for the unique biological behavior of KCOT.
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Profile of metabolic syndrome in newly detected hypertensive patients in India: An hospital-based study p. 32
Ravi Kant, Meenakshi Khapre
Background: Metabolic syndrome (MetS) is recognized as an emerging threat and interest of public health because the factors defining syndrome are associated with increased risk of mortality and morbidity. Hypertension further adds to risk factor leading to target organ damage. Recognizing the MetS in patients with hypertension provides a great opportunity for more aggressive treatment. Objective: The objective of the study is to estimate the prevalence and evaluate the metabolic profile of MetS in newly diagnosed adult hypertensive participants. Methodology: This is an hospital-based cross-sectional study. A total of 400 participants with newly detected essential hypertension were included in the study after detailed medical and laboratory investigations done to exclude the secondary hypertension. After the informed consent, a structured proforma was filled containing the demographic data; medical history; physiological parameters such as blood pressure, height, weight, and waist circumference; some laboratory investigations such as lipid profile and fasting blood glucose. Descriptive statistics such as mean and proportion were used. To compare the proportions, Chi-square test was used. Kappa agreement was utilized to know the level of agreement between various criteria defining MetS. Results: The prevalence of MetS according to the International Diabetes Federation criteria in the new hypertensive study participants was 50.5% more common in females. One-fourth of young hypertensives was having MetS. Hypertensive patients with MetS show risk factors at significantly higher range than their counterparts. High-density lipoprotein was the most common risk factor present apart from increased waist circumference. There was a wide variation in the prevalence of MetS in the Indian population by different criteria. Conclusion: Half of the new hypertensive patients had MetS and thus it becomes very important to screen all the hypertensives at the onset for MetS and treat them aggressively to decrease the cardiovascular events.
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Chronic versus new-onset hyponatremia in geriatric patients undergoing orthopedic surgery p. 37
Sumant Chacko Verghese, Anupam Mahajan, Bharti Uppal
Background: Hyponatremia is a common electrolyte disorder encountered in geriatric population undergoing an orthopedic surgery and is associated with adverse clinical outcomes. There is a paucity in literature comparing the effects of chronic- and new-onset hyponatremia on patient outcomes. Materials and Methods: A prospective study on 220 patients of age ≥60 years with an orthopedic injury was carried out over 1 year. The aim of this study was to determine the prevalence of chronic hyponatremia during hospitalization and the incidence of new-onset hyponatremia developing perioperatively and compare between the two groups with regard to the severity of hyponatremia, perioperative morbidities, serum sodium level trend in the early postoperative period, and mortality. Results: The prevalence of chronic hyponatremia was 14.1%, with an incidence of new-onset hyponatremia of 22.7%. Patients who developed new-onset hyponatremia were mostly of mild grade (130–134 mmol/L) and were significantly different from those with chronic hyponatremia who were more likely to be of profound grade (<125 mmol/L). When aggressively managed with adequate sodium corrections and strict monitoring, new-onset hyponatremia corrected within 48 h, whereas chronic hyponatremia had a gradual rise in serum sodium levels and did not achieve full correction within 48 h (P < 0.05). Those with chronic hyponatremia had a longer duration of hospital stay (P < 0.0001). No significant differences were obtained in mortality between the two groups. Conclusions: Patients developing new-onset hyponatremia are of milder grade and recover faster. Patients with chronic hyponatremia require a more cautious approach as they are more likely to be of profound grade and take longer time to correct.
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Clinicopathologic trends in pediatric oral biopsies: A 10-year institutional archival study p. 44
Varsha Salian, Pushparaja Shetty
Aim: The aim of this study is to determine the clinicopathologic trends in oral pathological biopsies in children aged 14 years and below received for histopathological diagnosis in the institution. Materials and Methods: The archives of the Department of Oral Pathology and Microbiology were retrospectively analyzed. Biopsy records of all oral lesions from pediatric patients, aged 0–14 years, in the files of the Department of Oral Pathology and Microbiology, A B Shetty Memorial Institute of Dental Sciences, Mangalore, DK, from 2007 to 2017 were considered. Descriptive statistical analysis and Pearson's Chi-square test using computer software were performed. Results: About 3,590 biopsies were received during the period of which 93 (2.6%) belonged to pediatric population. Prevalence was more in males (58%) compared to females (42%). Commonly affected age group was 10–14 years. The most common category of lesions diagnosed was cysts, and pulp pathologies were the least. The most common location was the jaws of which mandible was more common compared to maxilla followed by the lower lip and buccal mucosa. Histopathologically, radicular cysts (11%) were the most common followed by equal frequency of dentigerous cysts, mucoceles, and odontomes (9%). A statistically significant association of age and gender was seen with the category of the lesion. Conclusion: This study shows a blend of similarities and contradictions as compared to other similar studies, which could be attributed to geographical diversity, and a number of biopsies received each year which needs to be further explored.
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Candidal prevalence in diabetics and its species identification p. 49
Shweta Chouhan, Shreenivas Kallianpur, K Tukaram Prabhu, Manisha Tijare, Sowmya Kasetty, Sandeep Gupta
Context: Candida species is a part of the normal mouth flora. Diabetes mellitus is a predisposing factor for the onset of oral candidiasis. Aim: The objective of this study was to estimate salivary glucose in patient with diabetes and healthy individuals, to determine total candidal counts as well as different candidal species in the saliva of patients with diabetes and nondiabetics. Settings and Design: A sample size of 80 patients was taken. Out of 80 patients, 30 patients were uncontrolled diabetes patients (Group I), 30 patients were controlled diabetes patients (Group II), and 20 patients were healthy individuals (Group III). Subjects and Methods: From all the salivary samples, salivary glucose estimation was done using the glucose oxidase-peroxidase method. Candidal colony-forming units (CFUs) were determined from all the salivary samples. CHROMagar Candida medium was used for the identification of various Candida species. Statistical Analysis Used: One-way ANOVA was used to test for differences between the means of the three groups. Pearson's correlation coefficient test was used to evaluate the relationships between the variables. Results: The mean salivary glucose levels were higher in Group I followed by Group II and Group III. The mean candidal CFU was significantly higher in Group I than in Group II and Group III. Conclusion: Candida glabrata was the predominant species found and more so in patients with diabetes and needs further study. Other common species isolated was C. albicans. Species identification can help in better treatment strategies and gain good control over the disease.
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Blood pressure deviation from the golden ratio φ and all-cause mortality: A pythagorean view of the arterial pulse p. 55
Theodore G Papaioannou, Manolis Vavuranakis, Elias J Gialafos, Marianna Karamanou, Gregory Tsoucalas, Dimitrios A Vrachatis, Dimitrios Soulis, Danae Manolesou, Christodoulos Stefanadis, Dimitrios Tousoulis
Introduction: There is one mathematical element with strong historical and philosophical background that exhibits remarkable properties and applications; the golden ratio (phi). Mathematically, the golden ratio equals approximately 1.61803. A rather provocative geometrical analysis of the arterial pulse according to the golden ratio was recently described, and herein, we aim to set out the hypothesis that individuals with blood pressure (BP) values that follow the golden ratio may have different prognosis than those whose BPs deviate from the divine proportions. Materials and Methods: We used published data from the National Health and Nutrition Examination Survey during 1999–2010. Results: We found that the deviation of the BP values from the golden ratio is independently associated with all-cause mortality. Conclusions: This observation stimulates further research of the potential utility of the golden ratio of BP values on the diagnosis and prediction of BP-related abnormalities and risk.
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Bilateral nonsyndromic dentigerous cyst in a 10-year-old child: A case report and literature review p. 58
Bhawna Pant, Karla Carvalho, Anita Dhupar, Anita Spadigam
Dentigerous cysts are the most common developmental cysts of the jaws, accounting for approximately 20% of all jaw cysts. These cysts are usually unilateral, surrounding the crowns of impacted mandibular third molars. Bilateral dentigerous cysts have been associated with syndromes such as cleidocranial dysplasia and Maroteaux–Lamy syndrome. Nonsyndromic bilateral dentigerous cysts are extremely rare, particularly in the mixed dentition. Seventeen such cases have been reported till date. This article reports the eighteenth case of bilateral dentigerous cysts involving permanent maxillary canines in a 10-year-old boy.
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Sertoli-leydig cell tumor of ovary: A rare case report with heterologous elements and focal marked anaplasia p. 62
Parul Gautam, Meenakshi Rao, Meenakshi Gothwal, Pawan K Garg, Shilajit Bhattacharya
Sertoli-Leydig cell tumor (SLCT) of the ovary is an extremely uncommon neoplasm accounting for <0.5% of all primary ovarian neoplasms. These tumors belong to the category of sex cord-stromal tumors. The tumor has variable clinical and histopathological presentations complicating the diagnosis and therefore the treatment. The presence of heterologous elements is seen in one-fifth of these already rare neoplasms. Herein, we report a case of a 28-year-old female presenting with irregular menses, features of virilization, and abdominal pain. Histopathological examination revealed marked focal anaplasia in this tumor of, otherwise, intermediate differentiation along with the presence of heterologous elements. Reporting of such elements is imperative for adequate treatment and deciding follow-up.
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Re: Evaluation of thyroid lesions by fine-needle aspiration cytology p. 65
Beuy Joob, Viroj Wiwanitkit
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