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   Table of Contents - Current issue
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January-March 2020
Volume 10 | Issue 1
Page Nos. 1-64

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EDITORIAL  

Beta-blockers: A tale of triumphs, trials, and tribulations Highly accessed article p. 1
Jagjit Singh
DOI:10.4103/ijabmr.IJABMR_418_19  
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ORIGINAL ARTICLES Top

Long-term results of transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension in pediatric patients Highly accessed article p. 3
Jayal Hasmukhbhai Shah, Dharmin Khimjibhai Bhalodiya, Abhishek Pravinchandra Rawal, Tushar Sudhakarrao Nikam
DOI:10.4103/ijabmr.IJABMR_192_19  
Aims: Patent ductus arteriosus (PDA) is one of the most commonly seen congenital heart diseases prevalent today. The aim of this study is to evaluate the safety and efficacy of transcatheter closure of hypertensive ductus at long-term follow-up. Materials and Methods: Transcatheter closure was attempted in 52 patients with hypertensive ductus arteriosus. A lateral or right anterior oblique view aortogram was done to locate and delineate PDA. All the patients underwent clinical examination, electrocardiography, chest X-rays, and echocardiography before discharge and at 1, 6, and 12 months after the procedure and yearly thereafter. Results: The mean age of patients at procedure was 7.98 ± 4.79 (11 months–17 years), and the mean weight was 17.72 ± 10.81 (4–47) kg. Transcatheter closure of hypertensive ductus was successful in 50 (96.15%) patients. The mean preprocedural pulmonary artery pressure was 81.38 ± 17.31 (range: 55–113) mmHg which decreased to 29.65±8.63 (19-38) mmHg at follow up. The most commonly used device was Amplatzer duct occluder in 63% of the patients followed by Amplatzer muscular ventricular septal defect occluder in 37% of the patients. There were two procedural failures, namely aortic obstruction and left pulmonary artery stenosis, which were managed uneventfully. There were no procedural deaths or device embolization. At median follow-up of 86 months, all the patients are well with no complications. Conclusion: The long-term results suggested that transcatheter closure of PDA with severe pulmonary hypertension in pediatric patients is safe and effective with minimal complications.
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Prevalence of dengue fever in Western Uttar Pradesh, India: A gender-based study p. 8
Manoj Kumar, Rajesh Kumar Verma, Bishal Mishra
DOI:10.4103/ijabmr.IJABMR_337_18  
Objective: Gender-based serologic differences for nonstructural protein 1(NS1) antigen (Ag) and IgM antibody (Ab) detection have been reported among cases of dengue in few studies. However, to understand its distribution with patient's gender and their demographic profile, this study is designed to fill the gaps in the available gender based data, and is the first from this region. Materials and Methods: A total of 4252 blood samples were collected aseptically during the outbreaks of 2016–17. Serum was separated and processed for dengue ELISA (NS1Ag and IgM Ab). All the relevant clinical data and variables such as gender and their demographic profile were recorded and statistically analyzed. Results: A total of 978 (23%) patients were found seropositive either by NS1 Ag or IgM Ab ELISA. The proportion of male was higher than female among all seropositive cases, with the ratio of (M:F) 1.54:1 (P < 0.0001). The males were predominately more affected compared to females among rural (P = 0.001) and semi-urban (P = 0.016) areas. The positive NS1 (P = 0.004) and IgM (P = 0.0001) both results were significantly associated with male gender. Conclusion: Every case of dengue must be screened for NS1Ag and IgMAb to increase the diagnostic precision, despite the males being more affected as compared to females due to sociocultural differences.
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Intraoperative surgical margin clearance – Correlation of touch imprint cytology, frozen section diagnosis, and histopathological diagnosis p. 12
Ankita Narendra Tamhane, Samarth Shukla, Sourya Acharya, Neema Acharya, Kishor Hiwale, Arvind Bhake
DOI:10.4103/ijabmr.IJABMR_325_18  
Introduction: Touch imprint cytology (TIC) and frozen section diagnosis are valuable intraoperative guides for the management of malignancies as they make a prompt therapeutic decision that may prevent surgical re-intervention. The present study emphasizes on the correlation of TIC and frozen section for the evaluation of surgical margins considering histopathological diagnosis as the gold standard. Aim: The aim of the study was to assess the accuracy of frozen section diagnosis and TIC in the evaluation of surgical margin clearance. Materials and Methods: It is a prospective analytical study of 103 patients carried in the histopathology section of department of pathology for 1 year from July 2017 to July 2018. Specimens were received in the frozen section room, grossed by the standard protocol. Touch imprints of margins were taken, and frozen sections were stained by rapid hematoxylin and eosin stain. The same margins were sent for permanent histopathology sections. Results: Of 103 patients, 51 (49.51%) were oral squamous cell carcinoma, 35 (33.98%) carcinoma breast, 9 (8.74%) carcinoma colon, 4 (3.88%) squamous cell carcinoma of skin, 3 (2.91%) basal cell carcinoma, and 1 (0.97%) malignant peripheral nerve sheath tumor. Frozen section diagnosis for margin clearance of the above organs showed that the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were found to be 100%, 98.71%, 100%, 100%, and 99.02%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of TIC for surgical margin clearance were 46.15%, 100%, 100%, 84.62%, and 86.40%, respectively. Conclusion: Frozen section diagnosis is an accurate method for the assessment of surgical margin clearance as compared to TIC. This study evaluated predominantly epithelial malignancies than mesenchymal malignancies, thus emphasizing its utility in it. More research needs to be done for the assessment of the utility of these lesions.
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Morbidity pattern, availability and utilization of health services: A study among the male youth (15–24 Years) living in the slums p. 17
Sahil Sharma, Sanjeev Mahajan, Mohan Lal
DOI:10.4103/ijabmr.IJABMR_275_19  
Background: Youth is considered as a healthy period but their health is greatly influenced by the hostile living conditions in the slums. When this is accompanied by poor health infrastructure, health risk escalates multiple times. Objectives: The objective was (1) to study the health problems of the male youth living in the slums and (2) to study the availability and utilization of health services for the male youth living in the slums. Subjects and Methods: Study design: Cross-sectional study. Study population: Male youth (15–24 years). Study settings: Four urban slums of Amritsar city. Study period: January 1, 2017–December 31, 2017. Sample size: One thousand male youths. Inclusion criteria: Male youth (15–24 years) with consent. Exclusion criteria: Male youth (15–24 years) not given consent, not available at home on the third repeat visit, and mentally unstable or deaf or dumb. Results: The morbidity pattern showed that 47.5% suffered from any disease during the past 3 months and 3.3% were hospitalized in the past 1 year. Majority of the cases were due to diseases of the respiratory system and gastrointestinal system. Private health sectors including chemist shops were utilized more in case of both outpatient (88.9%) and inpatient services (57.6%) as compared to public health sector. The private health facilities were within 500 m from majority (89.6%) of households in the slums of Amritsar city. Conclusions: Primary health care needs to be strengthened in the slums. Effective and easily accessible health-care services should be provided by the government at the doorsteps of slum households. The Information Education Communication/Behavior Change Communication activities regarding disease prevention should be strengthened to promote and protect good health.
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Glycogen accumulation in neutrophil can be a marker of sepsis p. 22
Amit Ghosh, Pranati Nanda, Swagata Tripathy, Mithilesh Kumar Sinha
DOI:10.4103/ijabmr.IJABMR_350_18  
Background: Sepsis, a systemic inflammatory reaction to infection, is the leading cause of death in the world. The early detection and identification of pro-inflammatory changes in overall metabolism and functioning can help in the proper intervention and control of the inflammatory state, and it will improve the prognosis. Aim: In a resource-limited setting where the biomarkers are not easily accessible, this simple technique is required that can help in the early identification of infection and inflammation. Methodology: The present study was conducted to find the change in glycogen accumulation and morphological changes during inflammation by preparing a peripheral smear and periodic acid–Schiff (PAS) staining. Results: This study shows that the neutrophil accumulates glycogen granules throughout the cytoplasm with the presence of vacuoles in the cytoplasm, thus increasing the neutrophil size and chromatin dispersion. Conclusion: PAS staining can be used as a diagnostic method to detect sepsis.
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Can the surgical approach to total knee arthroplasty influence early postoperative outcomes? – A comparative study between trivector and medial parapatellar approaches p. 25
Gautam Reddy, Saif Ul Islam, Prakash Chandran, Fahad Attar
DOI:10.4103/ijabmr.IJABMR_176_19  
Background: Trivector approach to total knee arthroplasty (TKA) is a quadriceps tendon sparing approach, whereas the medial parapatellar (MPP) approach involves making a longitudinal incision in quadriceps tendon. We postulated that quadriceps-sparing approach such as trivector should make postoperative rehabilitation easier and ultimately reduce the length of hospital stay. Objectives: The aim of the study is to compare the early postoperative outcomes of the TKA performed through the trivector and the MPP approaches. Methodology: We prospectively reviewed the results of 56 consecutive patients operated on by two knee surgeons: one routinely performs trivector and the other an MPP approach. Both the groups consisted of 28 patients each. We looked at operative times, the time taken to perform straight leg raise (SLR), range of movements achieved before discharge, and length of the hospital stay. Results: The mean time taken for performing the surgery through the MPP approach was 56 min, whereas, for the trivector approach, it was 54 min (P = 0.31). The mean time taken to perform SLR in the MPP approach group was 3.5 days, whereas in the trivector group, the meantime taken for SLR was 2.5 days (P = 0.003). The average extension at the time of discharge in the MPP group was 3.8°, and in the trivector group, it was 0.86° (P = 0.007). The average knee flexion at the time of discharge in the MPP group was 84.2°, whereas in the trivector group, it was 86.5° (P = 0.199). The average hospital stay in the MPP group was 5.96 days, whereas in the trivector group, it was 4.84 days (P = 0.11). Conclusions: The trivector approach patients took significantly less time to do SLR and achieved a better range of extension before discharge from the hospital. The patients with trivector approach were discharged early by one day, although it is not statistically significant, it is clinically significant.
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Permanent anterior teeth fractures and its impact on oral health-related quality of life among 8–15-year-old schoolchildren of Chennai City – A cross-sectional survey p. 30
K Priya Deepa Lakshmi, MB Aswath Narayanan, SG Ramesh Kumar, A Leena Selvamary, A Sujatha
DOI:10.4103/ijabmr.IJABMR_346_18  
Background: Tooth fracture is not only a distressing experience on the physical level of a child, but it may also have an effect on emotional and psychological levels. This study aims to assess the permanent anterior teeth fractures and their impact on Oral Health-Related Quality of Life (OHRQoL) among 8–15-year-old schoolchildren of Chennai city. Materials and Methods: Thirty schools were randomly selected by stratified random sampling. All school-going children aged 8–15 years were invited to participate. A total of 7247 children were screened and 628 children with permanent anterior teeth fractures were included. Data were collected using Child Oral Health Impact Profile questionnaire. In addition, questionnaire addressing sociodemographic data and factors influencing permanent anterior teeth fractures were recorded. Descriptive statistics was performed to characterize the sample. One-way analysis of variance and Tukey's honestly significant difference post hoc tests was applied for multiple pair-wise comparisons. Results: The prevalence of permanent anterior teeth fracture was found to be 8.7%. The type of school had highly significant (P < 0.001) influence on the impact of permanent anterior teeth fracture on OHRQoL with negative OHRQoL among the corporation schools. The study participants of corporation schools had negative OHRQoL with significant difference in oral health well-being (P < 0.001) and self-image (P = 0.014). Conclusion: All the children reporting with tooth fractures had negative OHRQoL. The study stresses the importance of promoting good oral health-care practices to prevent oral disease in children and to meet children's unmet oral health-care needs.
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Detection of overexpression of efflux pump expression in fluoroquinolone-resistant Pseudomonas aeruginosa isolates p. 37
Nouf Al Rashed, Ronni Mol Joji, Nermin Kamal Saeed, Khalid Mubarak Bindayna
DOI:10.4103/ijabmr.IJABMR_90_19  
Context: Fluoroquinolones are the most effective antibiotics against Pseudomonas aeruginosa; many strains, however, have shown resistance due to mutations in DNA gyrase, topoisomerase IV, or in the efflux pumps. Little is known about P. aeruginosa efflux pump resistance mechanisms in the Kingdom of Bahrain. Aim: The aim was to study efflux pump-mediated fluoroquinolone resistance among P. aeruginosa isolates using phenotypic (E-test and agar dilution) and genotypic (real-time-polymerase chain reaction [RT-PCR]) methods. Materials and Methods: Fifty ciprofloxacin-resistant P. aeruginosa isolates were included in this study. Genus and species of P. aeruginosa were confirmed by conventional PCR. The minimum inhibitory concentration (MIC) of ciprofloxacin with and without carbonyl cyanide 3-chlorophenylhydrazone (CCCP) was determined by E-test and agar dilution test. The overexpression of genes MexB, MexD, MexF, and MexY was measured by RT-PCR. Results: All isolates were confirmed as P. aeruginosa. Among the fifty isolates, four showed reduction in ciprofloxacin MIC after addition of CCCP. These four isolates showed upregulation of expression of at least one of the four genes by RT-PCR. The mean gene expression of MexB, MexD, MexF, and MexY increased by 1.6, 4.65, 3.4, and 3.68-fold, respectively. Conclusion: The results demonstrate the presence and type of efflux pump overexpression, mandating for large multicentric studies.
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Prognostic significance of sodium iodide symporter and deiodinase enzymes mRNA expression in gastric cancer p. 43
Alok Mishra, Ashutosh Shrivastava
DOI:10.4103/ijabmr.IJABMR_287_19  
Context: Thyroid hormones (THs) are critically important for development, homeostasis, and metabolic regulation in mammals. Iodine, one of the constituents of TH, is actively supplied by sodium iodide symporter (NIS) into the thyroid gland. TH is subsequently transported to distant organs where its activation and deactivation is catalyzed by isoforms of deiodinases (DIOs). NIS protein has been known to overexpress in cancer cases of the breast and gastrointestinal organs. Recent studies show a possible role of DIOs in various cancers. Aims: In the present investigation, the prognostic significance of NIS and DIO-1, 2 and 3 was studied in gastric cancer using a data mining bioinformatic approach. Methods: “The Kaplan–Meier plotter” database was used for direct in silico validation in clinically relevant 876 gastric cancer patients with >15 years of follow-up information. After obtaining KM survival plots, hazard ratio and log-rank P value were calculated. Results: Increased expression of NIS and DIO 1-3 is significantly associated with worsen overall survival of gastric cancer patients followed for 20 years. Prognostic roles of NIS and individual DIOs were assessed in different types of gastric cancer classified based on morphologies, human epidermal growth factor receptor-2 receptor status, treatment choices, and different clinicopathological features. Conclusions: Based on these analyses, the present study found the indication of prognostic values of these genes. This information will contribute to better understanding of managing complex and heterogeneous gastric cancer. Further, these findings may be beneficial as a companion diagnostic tool predicting more accurate gastric cancer prognosis.
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Second-trimester maternal serum beta-human chorionic gonadotropin and lipid profile as a predictor of gestational hypertension, preeclampsia, and eclampsia: A prospective observational study p. 49
Sunita Murmu, Jyotsana Dwivedi
DOI:10.4103/ijabmr.IJABMR_271_19  
Background: Hypertensive disorders of pregnancy are important complications of pregnancy and are associated with high maternal and perinatal mortality and morbidity. Early diagnosis may improve maternal and perinatal outcome by ensuring appropriate management. Aim: Our aim is to assess the serum beta-human chorionic gonadotropin (hCG) and serum lipid profile in the early and late trimesters of at-risk mothers and to analyze whether these parameters can be used to predict pregnancy-induced hypertension (PIH) and its time of onset. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology, Tata Main Hospital, Jamshedpur, India. Two hundred antenatal women were screened for serum beta-hCG and lipid profile in their early (14–18 weeks) and late (24–28 weeks) second trimesters. All patients were followed up till delivery and observed for the development of PIH. Results were evaluated and analyzed statistically. Results: The incidence of PIH in our study was 14.67% (n = 27). Most of the patients had late-onset PIH (88.88%, n = 27), whereas 11.12% (n = 3) had an early onset of the disease. Of 27 patients, 6 patients developed preeclampsia and none had eclampsia. The mean beta-hCG level in the study population at the early second trimester was 91,723.97, whereas in the late second trimester, it was 22,456.25. In PIH patients, a significant increase in the level of serum cholesterol, triglyceride, and very-low-density lipoprotein was noted in both the early and late second trimesters. Conclusion: This study showed that serum beta-hCG and lipid profile in the second trimester are useful indicators to identify women who are likely to develop PIH, preeclampsia, or eclampsia.
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A comparative evaluation on the effect of oral zinc 50 mg with or without 0.1% triamcinolone orabase on oral lichen planus p. 54
Chintada Suvarna, Nallan C S K Chaitanya, Shaik Ameer, Himabindu Mannava, Parinita Bontala, Jabar Sadan Alyami, Humaira Samreen, Jayasurya Kondapaneni
DOI:10.4103/ijabmr.IJABMR_138_19  
Background: Lichen planus is a T-cell-mediated autoimmune disease, in which CD8+ T-cells releases the cytokines such as tumor necrosis factor-alpha and interleukin-12 disrupting basement membrane integrity. Treatment modalities were directed toward the relief in signs and symptoms and preventing recurrences. Zinc activates caspase-3 and DNA fragmentation, resulting in the apoptosis of keratinocytes. Prevention of matrix metalloproteinases1 (MMP1) activation, inhibits the Tcell accumulation in oral lichen planus (OLP) and by inhibiting MMP9, prevents the cleavage of collagen resulting in maintaining the integrity of the basement membrane. Objectives: The main objective of the study is to compare the efficacy of oral zinc 50 mg and 0.1% triamcinolone Orabase with 0.1% triamcinolone Orabase alone on the healing process of symptomatic OLP. Materials and Methods: A total of forty participants were randomly categorized into two groups: Group A and Group B with 20 patients with OLP and having symptoms of burning sensation. Group A patients had received 0.1% triamcinolone Orabase twice daily application. Group B patients had provided with oral zinc 50 mg and 0.1% triamcinolone Orabase twice daily for 8 weeks. The follow-up period for both the groups was 6 months. Lesional size was measured by Thongprasom scale and burning sensation was assessed by visual analog scale at each visit till the cessation of treatment. Results: There was decrease in the burning sensation and lesional size from the first visit to follow-up period which was statistically significant in both groups (P = 0.000). Conclusion: Oral zinc therapy was adjunctive in reducing the burning sensation and lesional size in the symptomatic OLP.
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CASE REPORTS Top

Filariasis with squamous cell carcinoma: A hidden surprise p. 59
Gaurav Sahu, Yashi Verma, Suhas Jajoo, Priyal Shrivastava
DOI:10.4103/ijabmr.IJABMR_309_18  
Squamous cell carcinoma (SCC) arising with chronic lymphedema is a rare condition, though literature suggests a variety of malignant tumors associated with filariasis. We present a case of 70-year-old male patient with a history of penile and scrotal SCC of filarial origin. We here discuss the unusual association of carcinoma and filariasis and its surgical treatment.
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Pulmonary infection by Chrysosporium species in a preexisting tuberculous cavity p. 62
K Ajay Gopal, V Kalaivani, Heber Anandan
DOI:10.4103/ijabmr.IJABMR_382_18  
We report a case of pulmonary disease due to Chrysosporium species in a preexisting tuberculous cavity in an immunocompromised male patient. The fungus was isolated from broncheoalveolar lavage fluid. The fungus was repeatedly isolated in culture, and the patient recovered with anti-tuberculosis treatment. Although the members of the genus Chrysosporium are common soil saprobes, they can occasionally cause systemic infections.
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