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   Table of Contents - Current issue
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April-June 2019
Volume 9 | Issue 2
Page Nos. 67-125

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EDITORIAL  

Quality medical research and publications in India: Time to introspect p. 67
Anil Kapoor
DOI:10.4103/ijabmr.IJABMR_28_19  PMID:31041165
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ORIGINAL ARTICLES Top

Asynchronous versus traditional teaching for MBBS undergraduate students-effectiveness and students perspectives - A pilot study p. 69
Vijendra Devisingh Chauhan, Juhi Kalra, Vinita Kalra, Gita Negi, Pradeep Agarwal
DOI:10.4103/ijabmr.IJABMR_260_18  PMID:31041166
Background: Traditional lectures continue to be one of the common ways of teaching practiced in medical schools across India. However, there are many other effective ways of teaching in large groups and lately e-learning modules, which can be synchronous, asynchronous, or blended, have been used to complement face-to-face interactions. E-assignments have been effectively used to engage students into meaningful learning. Aim: The aim of the study is to compare asynchronous teaching with traditional teaching in terms of student perspectives and learning. Materials and Methods: After taking ethical clearance from the Institutional Ethics Committee, the study was conducted involving 66 student volunteers from MBBS 2nd year. All the students were subjected to a pretest on the topic – “low backache” prior to the intervention. The students were then divided into two groups: Group A and Group B of 33 students each. Group A was taught by traditional lecture method, while Group B was given an e-assignment on the topic for which no face-to-face interaction was done earlier. The students from both the groups were then subjected to a posttest followed by feedback. Results: Analysis of covariance, considering the pretest score as a covariate, revealed that the two groups were comparable to begin with P = 0.632. After the intervention, posttest mean scores improved significantly (P < 0.001) within each group, for both the groups, but there was no significant difference in posttest scores on intergroup comparison (P = 0.507). Student feedback brought to light that 85% of the students felt that the traditional lecture method followed by e-learning would be of a great benefit to them. Conclusion: Although no single method emerged as superior over the other, student feedback revealed that 90% of the students graded e-module as either satisfactory to good. Most felt that lecture followed by e-modules will help them to learn better.
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Impact of sputum volume in the diagnosis of smear-positive pulmonary tuberculosis p. 73
T Jaya Chandra
DOI:10.4103/ijabmr.IJABMR_11_18  PMID:31041167
Objective: To find the impact of sputum volume in the diagnosis of smear-positive (SP) pulmonary tuberculosis (PT) and its association with gender. Materials and Methods: The study was conducted in the Department of Microbiology, GSL Medical College. PT patients were included and informed to provide good-quality sputum; volume was not mentioned. Smears were stained by Ziehl–Neelsen technique. Based on the volume of sample submitted, the participants were divided into three groups. Chi-square test was used to find the statistical significance; P < 0.05 was considered statistically significant. Results: Volume-wise, 22, 38, and 74 participants submitted sputum, respectively, in groups, <2 mL, 2–5 mL, and >5 mL; statistically, the difference was significant (P < 0.05). The smear positivity was 13% (15), 28% (32), and 59% (68), respectively, in groups, <2 mL, 2–5 mL, and >5 mL; statistically, the difference was significant (P < 0.05). Among the missed cases, the difference was statistically significant (P < 0.05) in males and the difference was statistically not significant (P > 0.05) in females. Conclusions: Notable number of SP cases are identified in ≤5 mL sputum. Hence, sample should not be discarded/rejected if the volume is <5 mL.
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Implementing resident research program to enhance physicians research in the United Arab Emirates p. 75
Mahera Abdulrahman, Ashraf Ahmed, Frederick Robert Carrick
DOI:10.4103/ijabmr.IJABMR_183_18  PMID:31041168
Objectives: The Dubai Residency Training Program (DRTP) commenced in the year 1993; then, a “Residency Research Program (RRP)” has implemented from 2011 to promote research among young physicians. This study was conducted by the Dubai Health Authority to review the RRP to assess its effectiveness in meeting original objectives and generating desired outcomes. Methods: Source documents such as the chronicles of the DRTP, communication between the stakeholders, resident feedback, research director, and program director reports were accessed and retrospectively reviewed. Results: Seven research workshops and ten advanced statistics courses were held. Ten scholarships were provided to the residents for “Introduction to Clinical Research Training” held by Harvard Medical School. Of 370 residents, a total of 156 residents submitted their research proposal, of which 128 residents presented their thesis. Nineteen residents presented their research on international conferences, 12 published their study, and 9 got award locally. Conclusions: Efforts are focused on improving the quality of the research projects, as well as getting residents involved in research that leads eventually to publication. Research is a major component of DRTP; nevertheless, it is challenging for residents to conduct research successfully because of some barriers inherent in residency training. This experience was the first in the United Arab Emirates, and we believe that this paper will contribute to the integrating research in residency programs by the educators and academics in across countries within the region.
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Variations in nitric oxide and endothelin serum levels in extracorporeal shock wave lithotripsy-treated patients p. 80
Emir Milisic, Mustafa Hiros, Edin Begic
DOI:10.4103/ijabmr.IJABMR_331_18  PMID:31041169
Introduction: Renal vasculature is extremely sensitive to vasoconstrictor effects of endothelin (ET), while nitric oxide (NO) has special role in several pathological renal conditions. Aim: The aim of this study to examine the presence, character, and degree of changes in NO and ET levels in the serum of extracorporeal shock wave lithotripsy (ESWL)-treated patients with nephrolithiasis. Patients and Methods: This study included a total of 60 patients that were divided in two groups: Group I (n = 24), in which a total of 2000SWs were administered; 0–2 units; (0.5 units per each 500SWs), and Group II (n = 36), in which a total of 4000SWs were administered; 0–4 units; (0.5 units per each 500SWs). Results: In the Group I median NO serum concentration increased in relation to pretreatment levels (39.04 ± 8.29 μmol/L) specifically 30 min, 60 min, and 24 h following the treatment (39.11 ± 12.60), (41.80 ± 6.89), and (46.33 ± 9.03), where concentration growth after 24 h was statistically significant P < 0.01. The NO serum concentration in the Group II increased in relation to pretreatment levels (38.90 ± 10.33 μmol/L) after 30 min (48.71 ± 30.09), 60 min (54.57 ± 39.76), and 24 h (97.95 ± 72.07). The NO concentration increase after 60 min and 24 h is statistically significant, respectively, P < 0.03 and P < 0.0001. Conclusion : NO and ET serum levels are changing under the influence of ESWL, and that the NO and ET changes are directly correlated with the number of administered shock waves and administered energy.
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Morphometric analysis of the orbital aperture in North Indian Population: A retrospective digital forensic study p. 85
Varsha Kanjani, Abha Rani, Deepak Kanjani
DOI:10.4103/ijabmr.IJABMR_404_18  PMID:31041170
Introduction: The morphometric variations seen in the orbital aperture play a significant role in forensic anthropology, for determining the personal and gender identification, especially in case of mass disasters. Aim: The aim of the present study was to evaluate the orbital aperture dimensions along with interorbital distance as observed on posteroanterior (PA) cephalograms for personal and gender identification. Materials and Methods: The present retrospective study was conducted to evaluate the morphometric dimensions of orbital aperture seen on PA cephalogram taken using PLANMECA digital machine and ROMEXIS software. The height and width of the orbits along with the interorbital distance were measured using measuring tools in the accompanying software. Data were analyzed using SPSS software version 21.0. Results: All the linear measurements such as orbital height, orbital width, and interorbital distance were significantly greater in males than females in the North Indian population with P = 0.001. The present study found 84.8% accuracy after subjecting the obtained value to discriminant function analysis. Conclusion: The morphometric analysis of the orbital aperture using postero-anterior cephalogram can be used as an adjuvant for personal and gender identification in forensic anthropology.
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Morton's toe: Prevalence and inheritance pattern among Nigerians p. 89
Eric Osamudiamwen Aigbogun, Ade Stephen Alabi, Blessing Chimezie Didia, Kenneth Shelu Ordu
DOI:10.4103/ijabmr.IJABMR_128_18  PMID:31041171
Background: Anatomical variations have been genetically linked and the difference in the length of the big toe relative to the second toe (Morton's toe) is not an exception; however, its prevalence and inheritance pattern has been a scientific debate. Therefore, this study investigated the prevalence and inheritance pattern of Morton's toe among Nigerians in Rivers State. Materials and Methods: A total of 101 families comprising of 101 parents (fathers and mothers) and 135 offspring were conveniently sampled for this study. The observed big toe pattern was described as “LBT” and “SBT” representing big toe longer than the second toe and big toe shorter or equal to the second toe, respectively. The offspring trait was tabulated alongside the parental combination patterns (i.e., when both parents had LBT, both parents SBTand a combination of LBTand SBT). XLSTAT 2012 (version 4.2.2) Chi-square analysis tested the association between sex and Morton's toe. Mendelian Chi-square gene distribution model evaluated the conformance to simple dominance-recessive pattern, while the Hardy–Weinberg (H-W) equation for allele frequency compared the parental allele frequency to that of the offspring. Results: LBT(218; 64.7%) was more in the studied population than SBT(119; 35.3%); with males (63; 18.7%) having slightly higher proportion of SBT (Morton's toe) than females (56; 16.6%), which was without sexual preference (χ2 = 0.141, P > 0.932). The test of offspring gene distribution in conformance to Mendelian simple dominant-recessive monohybrid cross had rather weak result. The H-W equation showed a deviation of offspring allele distribution (1:3:2.5 [2:6:5]) from the parents (1:3:2). Conclusion: Morton's toe could be said to be genetically linked, however, its inheritance pattern does not conform to the simple dominant-recessive model, but a more complex pattern. It should be noted that the large frequency of a trait in a population does not make it dominant.
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Rate of forced expiratory volume in one second and forced expiratory volume in one second/forced vital capacity decline among Indonesian patients with chronic obstructive pulmonary disease after a year of treatment p. 95
Wily Pandu Ariawan, Faisal Yunus, Triya Damayanti, Fariz Nurwidya
DOI:10.4103/ijabmr.IJABMR_254_18  PMID:31041172
Background: The rate of decline in lung function in chronic obstructive pulmonary disease (COPD) patients showed more profound decline than normal individuals. However, a 1-year lung function among Indonesian patients with COPD has not been elucidated. Aim: This study attempted to determine the rate of lung function decline in terms of obstruction variable among COPD patients after a 1-year of treatment. Materials and Methods: This retrospective cohort study measures the rate of decline in forced expiratory volume in 1 s (FEV1) and ratio of FEV1 to forced vital capacity (FEV1/FVC) in COPD patients at COPD Outpatient Clinic Persahabatan Hospital after 1-year of treatment. Results: There were 31 COPD patients with the prevalence of 1-year declined FEV1 and FEV1/FVC which were 83.9% and 51.6%, respectively. Among 1-year declined lung function group, there were significant (P < 0.05) decline in FEV1 (121.53 ± 120 ml/year) and in FEV1/FVC (2.75 ± 0.47%). The rate of decline in FEV1 was more prevalent in Group D, while the rate of decline in FEV1/FVC was more prevalent in Group B. No significant associations were found between sex, age, respiratory complaints, smoking history, Brinkman index, type of cigarette, comorbid, educational level, diagnosed age, body mass index, symptoms-based COPD classification, and risk-based COPD classification, with the rate of decline in FEV1 and FEV1/FVC. Conclusions: Most patients had statistically significant rate of decline in FEV1 and FEV1/FVC within 1-year of COPD treatment. This study recognized an unfavorable prognosis in terms of irreversible deteriorating lung function of COPD patients despite therapeutic management.
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Effect of Boswellia serrata extract on acute inflammatory parameters and tumor necrosis factor-α in complete Freund's adjuvant-induced animal model of rheumatoid arthritis p. 100
Rajendra Kumar, Sarvesh Singh, Anil Kumar Saksena, Rishi Pal, Riddhi Jaiswal, Rahul Kumar
DOI:10.4103/ijabmr.IJABMR_248_18  PMID:31041173
Context: The worldwide prevalence of rheumatoid arthritis (RA) is about 1%, whereas in India, it is approximately 0.75%. The current therapy for RA includes nonsteroidal anti-inflammatory drugs corticosteroids, disease-modifying anti-rheumatic drugs and some recently developed biologic agents, but all of these are associated with adverse effects. Some herbal drugs, such as Boswellia serrata, have been reported to possess anti-inflammatory activity. Aims: The aim of this study is to evaluate the anti-arthritic activity of Boswellia serrata extract (BSE) in complete Freund's adjuvant (CFA)-induced arthritis in rats. Materials and Methods: Thirty-six Wistar rats were divided into six equal groups. RA was induced by intradermal injection of 0.1 ml CFA in hind paw. Body weight, ankle diameter, paw volume, arthritic index, tumor necrosis factor-α (TNF-α), and histopathological examination were assessed. The experimental data were statistically assessed by one-way analysis of variance (ANOVA). Statistical Analysis Used: The recorded data were analyzed using paired t-test and ANOVA test using SPSS. The data were analyzed and represented as mean difference. Value of P < 0.05 was considered statistically significant. Results: BSE at dose 180 mg/kg showed statistically significant improvement in body weight and decrease in ankle diameter and arthritic index (P < 0.05); however, there was insignificant change in paw volume (P = 0.056). This improvement was comparable with Indomethacin. The level of TNF-α did not show any statistically significant change (P = 0.076). Histopathological results also exhibited a reduction in inflammatory parameters. Conclusions: BSE might have usefulness as an adjunct to conventional therapy of RA.
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CASE REPORTS Top

Pitfalls in fine-needle aspiration cytology diagnosis of ductal carcinoma in a lactating breast p. 107
Hajra K Mehdi, Kalyani Raju, C SBR Prasad, Manan B Shah
DOI:10.4103/ijabmr.IJABMR_147_18  PMID:31041174
Breast undergoes hormonal changes, especially during pregnancy and postpartum period and may be associated with benign and malignant lesions. These lesions can arise either de novo or can be an exacerbated change occurring in a preexisting breast lesion. The benign lesion in the lactating breast can show some degree of atypia due to the high levels of progesterone and prolactin which can mimic malignant features microscopically and can be overdiagnosed with breast cancer. On the other hand, breast cancer in the lactating breast can be underdiagnosed when the atypical cytological features are considered as hormonal changes. A few case reports are published in the literature regarding lactating adenoma undergoing malignant transformation. We present a case in 23 years postpartum lactating female with mass in bilateral breasts. Initially, the lesions were diagnosed with hormonal changes on cytology. On follow-up by fine-needle aspiration cytology and biopsy, it was diagnosed with infiltrating ductal carcinoma in both breasts. As far as our knowledge goes, this is the first-case report in the English literature of ductal carcinoma in the bilateral lactating breast arising de novo.
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Coronally advanced flap with amniotic membrane in the treatment of gingival recession: Three case reports p. 111
Vijayalakshmi Bolla, Pathakota Krishnajaneya Reddy, Butchibabu Kalakonda, Pradeep Koppolu, E Manaswini
DOI:10.4103/ijabmr.IJABMR_290_18  PMID:31041175
Gingival recession is defined as an apical displacement of soft tissues to the cementoenamel junction. Various treatment options for the management of gingival recessions include laterally positioned flap, double papillae flap, coronally advanced flap (CAF) with or without guided tissue regeneration, free gingival autografts, and autogenous subepithelial connective tissue grafts. Three patients with multiple adjacent gingival recessions in the upper jaw were treated utilizing amniotic membrane (Tata memorial) with CAF. The results of this procedure show that amniotic membrane can be used in the treatment of gingival recession defects with significant root coverage and to increase the thickness of keratinized gingiva. There was an increase in height and thickness of keratinized gingiva from 3 to 3.5 mm and 1.5 to 2 mm, respectively. The present results suggest that the combined approach of CAF and amniotic membrane can be considered as a treatment option for multiple adjacent gingival recessions.
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Pancreatic and gastric heterotopia in the gallbladder: A rare incidental finding p. 115
Devyani Pendharkar, Shaan Khetrapal, Zeeba Shamim Jairajpuri, Safia Rana, Sujata Jetley
DOI:10.4103/ijabmr.IJABMR_109_18  PMID:31041176
Heterotopic or ectopic tissue is a congenital anomaly, which is defined as the presence of the tissue outside its normal location, without neural, vascular, or anatomic connection with the main body of an organ in which it normally exists. This tissue is usually discovered incidentally and may be asymptomatic or may present with nonspecific gastrointestinal (GI) symptoms. Pancreatic and gastric heterotopia are the two predominantly occurring heterotopic tissues in the GI tract.[1],[2] The prevalence of ectopic pancreatic tissue in the GI tract ranges from 0.6% to 13.7% of autopsy series and it can be present anywhere in the GI tract with the most common localizations being stomach (27.5%), duodenum (25.5%), colon (15.9%), esophagus, and Meckel's diverticulum.[3],[4],[5] It is a rare finding in the gallbladder and its prevalence has not been ascertained due to lack of large-scale studies and systematic review of literature. Similarly, heterotopic gastric tissue is common throughout the GI tract from the tongue to the rectum,[6],[7] but it is extremely rare in the gallbladder with only around 34 cases reported in literature so far, while other cases of different types of heterotopic tissues in the gallbladder such as liver tissue and others such as adrenal and thyroid tissues have been described.[8] The most common presentation of ectopic tissue in the gallbladder is colicky pain in the epigastrium or right upper quadrant sometimes associated with nausea and vomiting. Here, we are presenting two incidentally detected cases, each of gastric and pancreatic heterotopias in the gallbladder.
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Feasibility of bisphosphonate therapy in an Indian pediatric patient of fibrodysplasia ossificans progressiva p. 118
Inderpal Singh Kochar, Aashish Sethi, Smita Ramachandran
DOI:10.4103/ijabmr.IJABMR_52_18  PMID:31041177
Fibrodysplasia ossificans progressiva, also known as myositis ossificans progressiva, is a rare autosomal dominant disorder (1 in 2 million). It produces a catastrophic and crippling illness in young people for which there is no effective treatment. This case report presents a case of 7-year-old child misdiagnosed as osteogenesis imperfecta admitted with severe disability and pain. He was diagnosed by clinical and radiological methods, treated with bisphosphonates for pain relief along with calcium and Vitamin D, and followed till 4 years.
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Adult alveolar rhabdomyosarcoma on extremity, successful treatment with radiotherapy following chemotherapy: Serial case report p. 121
Arundito Widikusumo, Lopo Triyanto, Rochmawati Istutiningrum, Schandra Purnamawati
DOI:10.4103/ijabmr.IJABMR_100_18  PMID:31041178
Alveolar rhabdomyosarcoma (RMS) is one of the four subtypes of RMS. Alveolar RMS is the rare type found in adults, with the worse prognosis. We report 2 serial cases of alveolar RMS on extremity which was only treated with subtotal excision or incision biopsy. We further gave a total dose of 70 Gy radiotherapy on the local tumor and 50 Gy prophylaxis dose on regional lymph node after 6 cycles of anthracyclines-based chemotherapy. Postradiotherapy, contrast computed tomography scan revealed no tumor mass left (complete response).
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LETTER TO EDITOR Top

Exposure to enriched environment may act epigenetically to correct defects due to chronic restraint stress in rats p. 124
Jacob Peedicayil
DOI:10.4103/ijabmr.IJABMR_389_18  PMID:31041179
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