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   Table of Contents - Current issue
October-December 2018
Volume 8 | Issue 4
Page Nos. 203-272

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Chondroitinase ABC enzyme: A potential treatment option for spinal cord injury Highly accessed article p. 203
Rajiv Mahajan
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Hepatitis B and C Viruses, their coinfection and correlations in chronic liver disease patients: A tertiary care hospital study Highly accessed article p. 204
Udhayvir Singh Grewal, Geeta Walia, Rupinder Bakshi, Siddharth Chopra
Introduction: There has been a rapid increase in the cases of viral hepatitis in Malwa region of Punjab. Quantification of seroprevalence of hepatitis B virus (HBV)/hepatitis C virus (HCV) and their coinfection among liver disease patients in tertiary care settings is needed to know the associated disease burden. Aim: The aim of this study is to analyze the seroprevalence of HBV, HCV, their coinfection, and implications in liver disease patients. Materials and Methods: This prospective study was conducted from June 2015 to August 2015 on a total of 100 chronic liver disease (CLD) patients. Venous blood samples were tested for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies by performing required serological tests using sandwich ELISA technique and solid-phase immunochromatography. Results: Out of 100 cases, 80 (80%) were male and 20 (20%) were female with mean age of 47.44 ± 14.56 years. Out of 100 cases of hepatic disorders, 26 were HBsAg positive and 40 were anti-HCV positive. Majority of the HBsAg-positive cases had alcohol as a risk factor (27%) and were diagnosed with cirrhosis (38.5%). Maximum number of anti-HCV-positive cases had blood transfusion as risk factor (30%) and were diagnosed with cirrhosis (45%). Out of total 62 seropositive cases, 4 had coinfection of HBV and HCV. Coinfected patients did not demonstrate greater risk of developing cirrhosis or progressing to hepatocellular carcinoma than mono-infected patients. Conclusion: HBV and HCV are the major causes of CLD at the place of study. Patients with dual HBV and HCV infection do not have greater risk of developing cirrhosis or progressing to HCC than mono-infected patients.
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Role of immunophenotypes in carcinoma breast p. 210
Samarth Shukla, Sourya Acharya, Sunita Vagha, Pratibha Dawande, Ankita Tamhane
Background: Nottingham's modification of Bloom–Richardson histopathological grading system (NGS) for carcinoma breast is a time-tested prognostic indicator; however, of lately, breast cancer has been evaluated through molecular techniques, particularly assessing the gene expression profiling and establishing molecular or immunophenotypes. The present-day utility of NGS needs to be reassessed with the modern predictive markers, this may help refine breast cancer classification specifically to help improve the treatment protocol. Objective: The objective was to compare breast cancer immunophenotypes with prognostic factors such as age (based on menstrual status), tumor size, lymph node (LN) status, also to compare the NGS grade with the molecular immunphenotypes of breast cancer. Materials and Methods: The present work was carried out in the Histopathology and Immunohistochemistry section of Department of Pathology, of a central Indian medical college and rural hospital from January 2013 to July 2016. It was a prospective analytical study. A tota1 of 114 female patients presenting in the outpatient department of surgery with lump in breast were included in the present study. All patients underwent modified radical mastectomy for tumor resection. Tumor masses and LNs were subjected to routine hematoxylin and eosin staining as well as immunohistochemistry then examined by a senior pathologist. Comparisons were made between molecular immunophenotypes with patient age, tumor size, and LN status, further NGS grade of breast cancer was compared with immunophenotypes. Results: The study found that the molecular immunophenotypes when compared with clinical prognostic parameters, i.e; age (based on menstrual status of female), LN involvement in patients of breast carcinoma showed inconsequential correlation, the tumor size showed significant correlation. However, when histopathological grades were compared with molecular immunophenotypes, a significant correlation was seen. Conclusion: NGS grade being an excellent predictive prognostic tool should be continued for assessing the grades in breast cancer patients. The molecular markers correlate with the histopathological grading and indirectly aid the oncologist in assessing the aggressiveness, these immunophenotypes are not helpful as suitable prognostic tools. As the molecular phenotypes definitely indicate the hormonal receptor status in breast cancer patients, they become mandatory in guiding oncologists for planning the treatment strategy and protocol.
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Human papillomavirus in urothelial carcinoma of bladder: An Indian study p. 217
Uttam K Mete, Sunil Shenvi, Mini P Singh, Anuradha Chakraborti, Nandita Kakkar, Radha Kanta Ratho, Arup K Mandal
Objectives: To study the role of high-risk human papillomavirus (HPV-16 and HPV-18) types in the causation of urothelial carcinoma of the urinary bladder in Indian population. Methods: 50 patients with Urothelial carcinoma of the urinary bladder were included in the study. Another 10 age-matched subjects who were hospitalized for transurethral resection of prostate for benign prostatic hyperplasia and/or ureterorenoscopy for ureteric stone disease were enrolled as controls. The tissue samples were analyzed for the presence of HPV-16 and HPV-18 DNA by polymerase chain reaction (PCR). The histopathology of the tumor tissue was carried out to assess the grade of the tumor. Results: The mean age of the patients was 54.1 years. A total of 28 (56%) patients had high-grade tumors and 22 (44%) had low-grade disease. T2 or higher stage disease was observed in 18 (36%) patients. All cancerous specimens and control specimens were found to be negative by PCR for the presence of HPV DNA. Conclusion: HPV prevalence in the urothelium is very low irrespective of the stage and grade of the disease, and hence, it is unlikely to be the causative agent for urothelial carcinoma of the urinary bladder in Indian population. However, the role of other HPV types in the etiology of this tumor needs to be clarified.
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Therapeutic effect of cell transplantation and chondroitinase in rat spinal cord injury p. 220
Durai Murugan Muniswami, George Tharion
Background: Spinal cord injury (SCI) leads to permanent functional deficits because the central nervous system lacks the ability for spontaneous repair. Cell therapy strategies offered a hope in neurological repair. The clinical use of human embryonic stem cell transplantation is hampered by scientific and ethical controversies. Olfactory ensheathing cells (OECs)/bone marrow mesenchymal stem cell (MSC) is a promising cell source for autologous neurotransplantation devoid of ethical concerns. Aim: This study aimed to evaluate the combined therapeutic effect of OEC, MSC, and chondroitinase in SCI rat models. Materials and Methods: Adult female albino Wistar rats were divided into ten groups, n = 6 rats in each group and control (n = 11). T10 level laminectomy was done in anesthetized rats to create drop-weight SCI. Both OEC and MSC were transplanted on the 9th day following SCI as a combined therapy with different dosage of 2 × 105, 5 × 105, 10 × 105, and >10 × 105 at a ratio of 1:1 with/without chondroitinase (0.2 U). One group of SCI rats was treated with chondroitinase alone 0.2 U. Dulbecco's Modified Eagle medium was injected in control rats. The outcome of transplantation was assessed using Basso, Beattie, Bresnahan (BBB) scale and motor-evoked potential studies. Results: All the treated groups showed hindlimb motor recovery in BBB score except control group (P < 0.05). All the three combinations showed better results than OEC + MSC groups in hindlimb motor recovery. In dose–response relationship, 5- and 10-lakh combinations elicited increased functional recovery than 2- and more than 10-lakh combinations. However, chondroitinase alone demonstrated a highest BBB score than any other groups. Conclusions: Chondroitinase/cell combinations have a therapeutic beneficial effect in SCI.
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Vitamin D levels: Do we need to assess only in disease? p. 227
Sunil Jamwal, Kapil Gupta, Tanvir Kaur Sidhu
Background: Vitamin D is conventionally known as sunshine vitamin and is synthesized endogenously in sunlight. Vitamin D is known to be a key regulator of bone metabolism, the function of genes, and essential for the development of the whole body. Deficiency of Vitamin D is now become a major worldwide epidemic health problem. Aim: The present study was conducted with the objective of determining the prevalence of Vitamin D deficiency (VDD) in urban population of a district in south Punjab, across various characteristics of population such as gender, age, and socioeconomic status. Materials and Methods: A cross-sectional population survey was conducted in the urban population of the district. A total of 120 healthy volunteers of either sex participated and their 25-hydroxy Vitamin D concentrations in serum samples were estimated using ELISA. The participants were divided into three categories as follows: Vitamin D deficient, insufficient, or sufficient, on the basis of normal standardized serum levels of Vitamin D <20, 20–30, and >30 ng/ml, respectively. Results: Of 120 healthy individuals, 95% of the study participants had VDD or insufficiency and only 5% had adequate Vitamin D levels. In each age group, females showed lower Vitamin D levels as compared to males. Furthermore, high body mass index value was associated with low Vitamin D. Upper-class individuals also showed low levels of Vitamin D as compared to other socioeconomic classes' individuals. Conclusions: Overall, high prevalence of VDD among the apparently healthy urban population of the district was observed and gives an alarming sign about continuously increasing prevalence of hypovitaminosis D among healthy population.
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Exposure to enriched environment restores altered passive avoidance learning and ameliorates hippocampal injury in male albino Wistar rats subjected to chronic restraint stress p. 231
Raju Suresh Kumar, Sareesh Naduvil Narayanan, Naveen Kumar, Satheesha Nayak
Aims: The aim of the study was to investigate the effects of exposure to enriched environment (EE) on passive avoidance learning and hippocampal cellular morphology in rats exposed to chronic restraint stress. Materials and Methods: Adult male albino Wistar rats were assigned into the following groups: normal control (NC) remained undisturbed in their home cages; stressed group (S) subjected to restrained stress (6 h/day) followed by housing in standard housing for 21 days; And stressed + EE (S + EE) subjected to restrained stress followed by housing in EE for 21 days. On 22nd day, six animals from each of the three groups were exposed to passive avoidance test. The remaining animals were sacrificed. Hippocampus was isolated and processed for cellular morphology using cresyl violet staining. Statistical Analysis Used: Data were analyzed using one-way analysis of variance followed by Tukey's multiple comparison test (post hoc). Results: Stressed rats exposed to EE showed significant improvement in passive avoidance learning test compared to NC. Quantification of the surviving neurons in the hippocampal subfields and their cellular morphology revealed significant neuroprotection in S + EE in cornu ammonis-2 (CA2) neurons and CA3 hippocampal neurons. No significant changes were found in CA1 hippocampal subfield. Conclusions: The outcome of this study makes us to think the possibilities of adopting EE as an alternative strategy in brain diseases where there is chronic stress and to minimize the impairment in learning and memory.
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Negotiating the curve of laparoscopic hepatopancreaticobiliary procedures (basic to advanced) at a tertiary rural teaching institute p. 237
Singh Mathuria Kaushal-Deep, Vikas Singh, Rudra Mani, Poonam Gupta, Mehershree Lodi
Background: We present here our experience of laparoscopic hepatopancreaticobiliary (HPB) surgeries at our rural institute and the hurdles we faced overcoming the various challenges. Aims and Objectives: The objectives of this study were to assess the feasibility, successful completion, operative time, conversions/requirement of assistance, duration of hospital stay, and postoperative complications on the HPB procedures performed laparoscopically in our surgical unit; and to help young surgeons for smooth navigation through their laparoscopic career. Materials and Methods: All the patients admitted under our unit over the past 9 years for elective HPB surgeries operated by a single surgeon were included in this study. Results: Total 1304 basic laparoscopic biliary procedures were successfully completed laparoscopically. After getting well versed with the standard procedure, we switched over to difficult cases involving densely adhered gallbladder, frozen Calot's, Mirizzi's syndrome, use of intraoperative cholangiogram, and take down of cholecystoduodenal fistulas. Next step in evolution was doing laparoscopic common bile duct exploration and biliary procedures with decreased number of ports. Five hundred and sixty-eight procedures were advanced HPB surgeries. With time, we also started performing a variety of complex advanced laparoscopic procedures such as cystogastrostomy, hepaticojejunostomy, choledochoduodenostomy, and pancreaticojejunostomy. All these procedures have been discussed with respect to operative duration, conversion rates, blood loss, hospital stay, and complication rates in the initial and later parts of the learning curves and further compared with previous standard large case studies on specific surgeries. Conclusion: Several hurdles are met in a new institute, that too, a rural one. The present discussion will help the budding surgeons to identify their deficiencies and chart a way forward in a systematic scientific manner.
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Correlation between domestic cigarette smoke exposure and respiratory complaints, hospitalization and school absence due to respiratory complains in the Indonesian elementary school-aged children p. 244
Priska Duana Putri, Agus Dwi Susanto, Achmad Hudoyo, Fariz Nurwidya, Feni Fitriani Taufik, Sita Andarini, Budhi Antariksa
Background: Over 43 million Indonesian children who are exposed to cigarette smoke are at risk of having health hazard and morbidities. Aims: The aim of this study is to identify the correlation between cigarette smoke exposure and respiratory complaints, hospitalization, as well as school absence due to respiratory complaints in elementary school-aged Indonesian children. Materials and Methods: A cross-sectional study was conducted in nonsmoking elementary school-aged children. Participants were categorized into the exposed and unexposed groups based on the report of their parents. Questionnaire-retrieved data were analyzed to identify the correlation between cigarette smoke exposure and respiratory complaints, hospitalization, as well as school absence due to respiratory complaints in elementary school-aged children. Results: A total of 128 study participants of nonsmoking children aged 6–12 years (mean 9.8 ± standard deviation 1.6 years) were categorized into 64 children exposed and 64 children unexposed to domestic cigarette smoking. There was a significant correlation between smoking exposure and cough episodes as well as upper respiratory infection in children within the past 12 months. A cough episode of ≥3 times/year was found more prevalent in exposed children compared to the unexposed children (26.6% vs. 9.4%; P < 0.05). Cough ≥3 times/year was found in 50% of children exposed to cigarette smoke of a smoker with a smoking habit of >10 cigarettes/day. There was a correlation between cigarette smoke exposure and hospitalization frequency of ≥1 time(s)/year due to respiratory complaints in children (P < 0.05). Conclusion: Cigarette smoke exposure is correlated with complaints of cough, upper respiratory tract infection, and hospitalization due to respiratory complaints in children.
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Gestational toxicity of Calabash chalk (Nzu) in Wistar rats p. 249
Jonah Sydney Aprioku, Ezinne Margaret Ogwo-Ude
Objective: Calabash chalk (Nzu) is a geophagic material, consumed by many pregnant women and breastfeeding mothers as remedy for morning sickness in most African countries. The present study aims to evaluate the impact of Calabash chalk consumption in pregnant Wistar rats. Materials and Methods: Median lethal dose of Calabash chalk was initially determined in Wistar rats to be >5000 mg/kg po using Lorke's method. Thereafter, 24 pregnant Wistar rats were divided randomly into 3 groups (n = 8) and orally administered 0, 400, or 800 mg/kg of Calabash chalk from gestation day 0 to 20. Maternal body weights were monitored during sample administration. Fetuses were delivered under anesthesia by cesarean section and pregnancy outcome was assessed. Results: Calabash chalk exposure inhibited maternal weight gain. Uterine implantations were absent in 85% of Calabash chalk exposed rats, and the number of implantation sites were decreased (P = 0.0262) in the rest, compared to control. Uterine weight and the number of fetuses formed in uterine horns of Calabash chalk exposed pregnant rats were decreased (P = 0.0204) when compared with control. In addition, there was resorption of pregnancy, abortion (58%), and stillbirth (5%) in Calabash chalk exposed rats, and fetuses delivered were sluggish and pale. Most of these effects observed were dose-dependent. Conclusion: The results suggest that Calabash chalk has a negative relationship with maternal health and pregnancy outcome.
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Dermal lymphatic invasion: A rare feature in benign intradermal nevus p. 253
Neelam Sood, Moushmi Mukherjee
The present case describes classical intradermal nevus with intralymphatic nevus cell emboli. A 13-year-old boy presented with black colored macule on the shin 1 cm in diameter which was gradually increasing in size. Histopathology of the lesion was typical of an intradermal melanocytic nevus. The most notable feature of this case, however, was an occasional aggregate of nevus cells within a lymphatic vessel of the upper dermis. The nevus cells within lymphatic lumen had morphological features of type A nevus cells. The cells were roundtocuboidal, exhibited abundant cytoplasm with welldefined cell borders and formed nests. These nevus cell aggregates were surrounded by flattened endothelial cells. Due to its rarity, a lymphatic nevus cell embolus creates diagnostic issues for pathologists. This observation must not be interpreted as evidence of malignancy but significant as a rare histological feature. In other words, the nevus cells might have been transported through the lymphatic vessels as a “benign metastasis.”
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A unique conglomeration of variations in the celiac, hepatic, and superior mesenteric artery: A clinico-embryological perspective p. 256
Anita Mahajan, Swati Tiwari, Sabita Mishra
This paper highlights a rare variation in the branching pattern of the celiac trunk and superior mesenteric arteries, as observed during cadaveric dissection. It was found that the celiac trunk gave origin to the following: (1) left inferior phrenic artery, (2) hepatogastric trunk which gave three branches: the left gastric artery, esophageal branch, and a left hepatic artery, (3) splenic artery, and (4) common hepatic artery. The superior mesenteric artery gave origin to the right hepatic artery, and the common hepatic artery gave origin to a middle hepatic artery. Such rare variations must be brought to the notice of surgeons and radiologists to prevent any undue complications during any interventional procedures and surgeries.
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Unicentric Castleman's disease as a localized retroperitoneal mass: A case report and review of literature p. 259
Praveen Gopi, Vasudevan Sambu Potty, Rustam Singh Kaurav, Krishna Govindan
Castleman's disease (CD) is a rare disorder characterized by proliferation of the lymphoid tissue. Clinically, it presents in two forms either a unicentric (UC) or multicentric. Mediastinum is the most common location. UC retroperitoneal presentation is rare. We report a case of 29-year-old female who presented with left loin pain, and on abdominal imaging, evaluation identified a retroperitoneal mass in the left hypochondrium in the pararenal space. Mass was surgically excised entirely. Histopathological examination demonstrated hyaline vascular type of CD. CD should be considered in differential diagnosis of retroperitoneal mass, especially in equivocal cases. We also reviewed literature of 134 cases of retroperitoneal CD to analyze the presentation, management, and outcome.
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Sepsis in a 4-month-old boy due to carbapenem-resistant Enterobacteriaceae characterized by AmpC β-lactamase with porin loss p. 263
Junji Shimizu, Takashi Taga, Tomomi Sato, Yutaka Eguchi
The incidence of carbapenem-resistant Enterobacteriaceae (CRE) infections is increasing, and these infections are associated with both morbidity and mortality. However, little is known about CRE infections in children. This article is a case report describing a 4-month-old boy with Langerhans histiocytosis who developed septic shock due to a CRE infection. The mechanism of carbapenem resistance was identified as AmpC β-lactamase hyperproduction with porin loss. The patient was treated with antibiotics, volume resuscitation, and vasopressors; however, he died of multiorgan failure due to CRE infection. Clinicians should be aware of the prevalence of CRE and the importance of prevention strategies against infection with multidrug-resistant bacteria, even in pediatric populations.
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A curious case of ankylosing spondylosis and motor neuron disease: A mere coincidence or correlation? p. 266
Biswajit Roy, Sarbani Sengupta, Kaushik Ghosh, Sarmistha Mukhopadhyay, Bhaskar Ghosh
Ankylosing spondylitis (AS) is a chronic (progressive) painful inflammatory rheumatic disease with genetic predisposition. Genetic susceptibility and common expression cause susceptibility to other inflammatory diseases such as psoriasis, ulcerative colitis, and Crohn's disease. However, cases of motor neuron disease (MND) in patients of biologically treated patients of AS have been rarely reported. AS does not follow the same course in everyone; even among affected members of one family, the outcome varies. Here, we present a case of an unusual AS without expression of human leukocyte antigen-B27 genetic marker who subsequently develops amyotrophic lateral sclerosis the most common form of MND. This mere correlation of one noncurable disease with one potentially treatable chronic rheumatological condition adds our knowledge to existing literature.
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Cerebral aspergillosis mimicking a neoplasm in an immunocompetent patient p. 269
Zafar Neyaz, Vivek Singh, Anant Mehrotra, Manoj Jain
Cerebral aspergillosis mostly presents as single or multiple abscesses with vascular invasion in immunocompromised patients. A rare mass like or tumoral form of cerebral aspergillosis has been described mostly in immunocompetent patients. A 22-year-old-male presented with recurrent attacks of complex partial seizures with secondary generalization, headache, and blurring of vision. Preoperative diagnosis of a cerebral neoplasm was considered in view of solid mass-like enhancement. However, histopathological examination was suggestive of central nervous system aspergillosis. The presence of imaging findings such as T2 hypointensity, irregular frond-like margins, and absence of choline peak may be the clues, which suggest a fungal etiology.
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Erratum: Sleep paralysis, a medical condition with a diverse cultural interpretation p. 272

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