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   2014| September  | Volume 4 | Issue 3  
    Online since September 15, 2014

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Oxidative stress indices in Nigerian pesticide applicators and farmers occupationally exposed to organophosphate pesticides
Yaqub A Surajudeen, Rahamon K Sheu, Kosoko M Ayokulehin, Arinola G Olatunbosun
September 2014, 4(3):37-40
DOI:10.4103/2229-516X.140730  PMID:25298941
Background: Reports have clearly indicated the role of oxidative stress in the pathogenesis of organophosphate pesticides (Op) toxicity. However, there is dearth of information on which group of the farm workers is more at risk of Op-induced oxidative stress. Aim: This study determined serum levels of malondialdehyde (MDA), catalase (CAT), glutathione peroxidase (GPx), reduced glutathione (GSH), myeloperoxidase (MPO), nitric oxide (NO), and serum activity of acetylcholinesterase (AChE) in farm workers exposed to Op. Subjects and Methods: A total of 60 (30 pesticide applicators and 30 farmers) and 30 apparently healthy non-farmers who were nonexposed to Op (controls) were recruited into this study. Serum activity of AChE was determined using high performance liquid chromatography (HPLC), while serum levels of MDA, GSH, and NO and serum activities of CAT, MPO, GPx, and superoxide dismutase (SOD) were determined colorimetrically. Results: Serum activities of AChE and CAT were significantly lower, whereas MPO activity was significantly higher in pesticide applicators compared with controls. Similarly, farmers had significantly reduced serum AChE activity and significantly raised MPO activity compared with controls. However, serum activities of AChE, CAT, and MPO were significantly lower, whereas mean level of MDA was significantly higher in pesticide applicators compared with farmers. Conclusion: This study shows that Op applicators are more exposed to oxidative stress than farmers, thus Op applicators require increased antioxidant supplements than farmers.
  12 2,193 385
Dentigerous cyst in association with impacted inverted mesiodens: Report of a rare case with a brief review of literature
Shamimul Hasan, Syed Ansar Ahmed, L Bhaskar Reddy
September 2014, 4(3):61-64
DOI:10.4103/2229-516X.140748  PMID:25298949
Dentigerous cyst is a developmental odontogenic cyst, which develops due to fluid accumulation between the reduced enamel epithelium and unerupted tooth crown. The condition is frequently seen with the permanent dentition, usually associated with impacted mandibular third molars and maxillary canines. Rarely, dentigerous cyst occurs in association with a supernumerary tooth. Pain, swelling, and facial asymmetry are occasionally seen; however, they are usually asymptomatic and observed during radiographic examination. Early diagnosis and treatment planning entails thorough history taking, clinical and radiographic examination coupled with histopathology. This article reports an unusual occurrence of dentigerous cyst of anterior maxillary region seen with an inverted impacted mesiodens cyst enucleation along with extraction of the mesiodens was carried out and no complications were observed during the follow-up.
  7 3,149 439
Correlation of insulin resistance by various methods with fasting insulin in obese
Kanwal Mohinder Dev Singh Panag, Navneet Kaur, Gitanjali Goyal
September 2014, 4(3):41-45
DOI:10.4103/2229-516X.140733  PMID:25298942
Background: Several studies indicate that obesity is closely related to insulin resistance (IR). However, this relationship has not been adequately explored. Aims: This study aims to evaluate the prevalence of IR among obese using some indirect methods for assessment of IR. Materials and Methods: We analyzed the correlation of fasting insulin (FI) with body mass index. We examined 100 obese and overweight. Anthropometric measurements were done for all individuals. Blood lipids parameters, glucose, and insulin were assayed after a 10 h fast. The indices McAuley (McA), homeostasis model assessments (HOMA), quantitative insulin sensitivity check index (QUICKI) were used to assess IR. Results: In this study, the correlations of FI with McA, HOMA and QUICKI were significant (P < 0.05). FI test had significant sensitivity and specificity when compared with McA, HOMA and QUICKI indices. FI gives parallel results to the assessment of IR by other methods. Validity of FI was further analyzed by Cohen's kappa test and had a satisfactory agreement (χ =0.940). Conclusion: Altogether, this study suggested that FI was sensitive and also specific as McA in assessment of IR in obese. Thus, FI can be used as an easy test to detect IR also in obese.
  5 2,100 304
A study of calcaneal enthesophytes (spurs) in Indian population
Jagdev Singh Kullar, Gurpreet Kaur Randhawa, Keerat Kaur Kullar
September 2014, 4(3):13-16
DOI:10.4103/2229-516X.140709  PMID:25298934
Introduction: Calcaneus or os calcis forms a major component of the skeleton of foot providing posterior pillars for bony arches of the foot. It is largest of seven tarsal bones of foot and forms prominence of heel. Many times anterior to calcaneal tuberosity an osteophytic outgrowth has been observed (calcaneal or heel spur) extending along entire width, for about 2-2.5 cm. The apex of spur seen embedded in plantar fascia, directly anterior to its origin. Hence, the study of calcaneal spurs has been undertaken. Materials and Methods: The material for the study consisted of 200 dry (100 right and 100 left), adult calcanei of unknown age and sex obtained from Department of Anatomy. The calcaneal enthesophytes/spurs were studied in detail and classified according to types of calcaneum. Results: Maximum incidence of calcaneal spurs were found in Type I calcanei (11%) and no calcaneal spurs were found in Type III calcanei. Total incidence of dorsal calcaneal spurs in all types of calcanei was maximal (15.5%). The incidence of plantar spurs was 6.5% being highest in Type I calcanei (4%). The incidence and type of calcaneal spurs were compared with those of previous studies and etiology of heel pain has been discussed. Correlation between type of calcanei and spurs has been studied for the 1 st time. Conclusion: Calcaneal spurs are related to type of calcanei with the highest frequency in Type I and least in Type III (no spurs seen in Type III and least in Type IV). Other factors, which contribute toward increase in incidence of spurs, are increasing age and weight, concurrent orthopedic diseases, and heel pain.
  5 3,898 644
Infected pseudoaneurysms in intravenous drug abusers: Ligation or reconstruction?
Navdeep Singh Saini, Anil Luther, Amit Mahajan, Allen Joseph
September 2014, 4(3):23-26
DOI:10.4103/2229-516X.140715  PMID:25298938
Background: Infected pseudoaneurysm in intravenous (IV) drug abusers is a serious clinical problem, with difficult and controversial management. With existing controversies regarding their optimal management, we present the results of simple ligation and local debridement for treatment of infected pseudoaneurysms. Patients and Methods: Records of 72 consecutive patients with pseudoaneurysms in IV drug abusers over the last 20 years were reviewed retrospectively. Results: Ligation and excision of pseudoaneurysm was done in all patients with delayed revascularization in only two patients. Four patients had amputations because they had gangrenous limbs on presentation. All other patients had healthy limbs at the time of discharge. There were three deaths, two due to sepsis with multiorgan dysfunction and one with hemorrhagic shock. Conclusion: Infected pseudoaneurysm should be managed by simple ligation of involved artery with delayed revascularization, if required.
  4 1,702 229
Transfusion support in patients with dengue fever
Paramjit Kaur, Gagandeep Kaur
September 2014, 4(3):8-12
DOI:10.4103/2229-516X.140708  PMID:25298950
Dengue fever has emerged as a global public health problem in the recent decades. The clinical spectrum of the disease ranges from dengue fever to dengue hemorrhagic fever and dengue shock syndrome. The disease is characterized by increased capillary permeability, thrombocytopenia and coagulopathy. Thrombocytopenia with hemorrhagic manifestations warrants platelet transfusions. There is lack of evidence-based guidelines for transfusion support in patients with dengue fever. This contributes to inappropriate use of blood components and blood centers constantly face the challenge of inventory management during dengue outbreaks. The current review is aimed to highlight the role of platelets and other blood components in the management of dengue. The review was performed after searching relevant published literature in PubMed, Science Direct, Google scholar and various text books and journal articles.
  4 4,792 962
Intricacy of missing data in clinical trials: Deterrence and management
Richa Singhal, Rakesh Rana
September 2014, 4(3):2-5
DOI:10.4103/2229-516X.140706  PMID:25298936
Missing data is frequently encountered in clinical studies. Unfortunately, they are often neglected or not properly handled during data analysis and this may significantly bias the results of the study, reduce study power and lead to invalid conclusions. Substantial instances of missing data are a serious problem that undermines the scientific trustworthiness of causal conclusions from clinical trials. The assumption that statistical analysis methods can compensate for such missing data is not justified. Hence aspects of clinical trial design that limit the probability of missing data should be an important objective, while planning a clinical trial. In addition to specific aspects of trial design, many components of clinical trial conduct can also limit the extent of missing data. The topic of missing data is often not a major concern until it is time for data collection and data analysis. This article discusses some basic issues about missing data as well as prospective "watch outs" which could reduce the occurrence of missing data. It provides some possible design considerations that should be considered in order to alleviate patients from dropping out of a clinical trial. In addition to these the concept of the missing data mechanism has also been discussed. Three types of missing data mechanisms missing completely at random, missing at random and not missing at random have been discussed in detail.
  3 2,063 1,223
Inhibition of biofilm formation and lipase in Candida albicans by culture filtrate of Staphylococcus epidermidis in vitro
Sayan Bhattacharyya, Prashant Gupta, Gopa Banerjee, Amita Jain, Mastan Singh
September 2014, 4(3):27-30
DOI:10.4103/2229-516X.140721  PMID:25298939
Background: Candida spp. are fourth most common cause of bloodstream infection in developed countries and emerging agents of fungemia in developing countries, with considerable attributable mortality. Candidemia is associated with the formation of complex, structured microbial communities called biofilms. Biofilm formation makes treatment difficult due to improper drug penetration and factors like high cost and adverse effects of antifungal drugs available. Hence, low-cost alternatives are urgently required to treat device-associated invasive candidiasis. Objectives: To study the effect of culture filtrate of Staphylococcus epidermidis on biofilm formation and lipase expression of Candida albicans in vitro. Materials and Methods: Yeast cells isolated from clinical samples were suspended to a turbidity of 10 6 in (a) Yeast extract-peptone-dextrose (YPD) broth and (b) culture filtrate, and 100 μl of each were dispensed in separate wells of microtiter plate. After repeated washing and reloading with respective liquid media, readings were taken spectrophotometrically. To check for lipase inhibition, yeasts were incubated overnight in YPD and filtrate and subcultured on media containing Tween-80 and CaCl 2 . Positive lipase activity was denoted by haziness around colonies. Results: Mean reading of C. albicans in YPD broth was 0.579 while the same when yeasts were suspended in S. epidermidis culture filtrate was 0.281 (P < 0.05 by Z-test of significance). Lipase of C. albicans was inhibited by culture filtrate. Filtrate was found to be nontoxic to human cell line. Conclusions: Culture filtrate of S. epidermidis can hence pave the way for development of new strategies to inhibit biofilm formation in device-associated candidemia.
  3 1,748 289
Evaluation of the anti-proliferative and cytostatic effect of Citrus sinensis (orange) fruit juice
Enegide Chinedu, David Arome, Solomon F Ameh, Gift E Ameh
September 2014, 4(3):20-22
DOI:10.4103/2229-516X.140711  PMID:25298937
Aim: This work has been designed to evaluate the anti-proliferative and cytostatic effects of Citrus sinensis (orange) fruit juice on rapidly proliferating cells. Materials and Methods: The study was carried out on the seeds of Sorghum bicolor for 72 h. The mean radicle length (mm) of the seeds was taken at 48 and 72 h. Result: The result showed that when compared with the control, methotrexate, the standard drug showed a significant (P < 0.001) anti-proliferative effect throughout the experiment. The inhibition of the radicle growth was more after 72 h (87.42%). At a dose of 5% (v/v), the juice showed a slightly significant (P < 0.05) effect affect after 72 h; however, there was no significant effect at 48 h. The juice at doses of 10% and 20% (v/v) showed a highly significant (P < 0.001) anti-proliferative effect throughout the experiment; however, the percentage inhibitions were higher at 72 h. At 72 h, the percentage inhibition for juice at 10% (v/v) was 72.37% and at 20% (v/v) was 91.96%. The concentrations of 40% and 60% (v/v) showed cytostatic effects as no appreciable growth of the radicles of the seeds was observed throughout the experiment. The percentage inhibition for 40% (v/v) was 100% and 99.72% for 48 and 72 h, respectively, while that for the juice concentration of 60% (v/v) was 100% throughout the study. Conclusion: The experiment has shown that C. sinensis fruit juice has a potential for causing both anti-proliferative and cytostatic effects on fast proliferating cells and hence cancerous cells.
  2 1,967 262
A change in the management of intractable obstetrical hemorrhage over 15 years in a tertiary care center
Sunil K Juneja, Pooja Tandon, Bishav Mohan, Sandeep Kaushal
September 2014, 4(3):17-19
DOI:10.4103/2229-516X.140710  PMID:25298935
Context: Peripartum hysterectomy was the gold standard to save a woman with persistent obstetrical bleeding, but compromised the menstrual and reproductive functions. Bilateral internal iliac artery ligation (BIAL) is a potentially effective, fertility preserving means of controlling pelvic hemorrhage, but with surgical and anesthetic risks and low success. Angiographic embolization has the potential to arrest severe pelvic hemorrhage without removing the uterus and without hazarding general anesthesia in a hemodynamically unstable patient. Aims: The aim of this study is to discuss change in the management of intractable obstetrical hemorrhage from removing to conserving the uterus over 15 years. Settings and Design: A retrospective analysis of 122 cases of intractable obstetrical hemorrhage over a period of 15 years (January 1997 to December 2011) was done. We started uterine artery embolization (UAE) in 2007 for obstetrical hemorrhage. The patients were analyzed for maternal characteristics, indications, treatment modality, maternal morbidity, and mortality. Statistical Analysis Used: Descriptive. Results: We analyzed 12,055 deliveries, (6029 cesarean sections; 6026 vaginal deliveries). One hundred and twenty-two cases of intractable obstetrical hemorrhage were managed with obstetrical hysterectomies in 63, UAE in 53 cases and BIAL in six cases. During the period between 1997 and 2006 intractable obstetrical hemorrhage was managed by hysterectomy/internal iliac artery ligation. The last 5 years of the study period had 80 patients with intractable obstetrical hemorrhage, 53 patients underwent arterial embolization and 35 had a hysterectomy and two had internal artery ligation. There was no mortality and significantly less morbidity in embolization group in our study. Conclusions: Embolization should be tried in patients with intractable obstetrical hemorrhage before proceeding for surgical intervention.
  2 1,768 449
The effectiveness of diclofenac gel and eutectic mixture of local anesthetic cream on vein puncture pain severity with vein catheter in patient undergoing cesarean section: A randomized, double-blind, placebo-controlled trial
Sediqeh Khalili, Mahboubeh Safavi, Rozita Rezaei, Maria Bidmeshki, Fatemeh Shirzad, Mostafa Nasiri
September 2014, 4(3):46-49
DOI:10.4103/2229-516X.140739  PMID:25298943
Aim: This study was aimed to explore the effect of applying diclofenac gel and a eutectic mixture of local anesthetic (EMLA) cream on vein puncture pain severity with vein catheter in the patients undergoing cesarean section. Materials and Methods: The sample comprised 90 women undergoing elective cesarean section that referred to Imam Ali Hospital's maternity section in Amol city (Northern Iran). Data collection tools included visual analog scale for pain severity and a checklist for short term possible side-effects of diclofenac gel, EMLA cream and Vaseline ointment as placebo. Results: The pain of vein puncture with diclofenac gel and EMLA cream was significantly lower than that with the Vaseline ointment (P = 0.001). Similarly, there was a significant difference between using diclofenac gel and EMLA cream in catheter insertion pain severity (P = 0.006). In addition, there was no short term possible side-effect with using diclofenac gel and Vaseline ointment, but a short term side-effect (blanching) was detected in 20% of subjects with EMLA cream. Conclusion: Compared to Vaseline cream, EMLA cream and diclofenac gel application significantly reduces the pain severity associated with vein catheter insertion. Use of diclofenac gel is preferred compared with EMLA cream, because of economics, more efficiency purpose, and no side-effects.
  2 2,201 261
Desmoplastic ameloblastoma
Sumit Majumdar, Divya Uppala, Sreekanth Kotina, Sravanthi Karukonda Veera, Rajyalakshmi Boddepalli
September 2014, 4(3):53-55
DOI:10.4103/2229-516X.140743  PMID:25298945
Desmoplastic ameloblastoma is a relatively rare variety of ameloblastoma and only very few cases have been reported so far. The present case is an elderly man who had reported with a swelling in the anterior mandible which turned up to be desmoplastic ameloblastoma. Proper diagnosis is necessary to report such a case, so that the actual incidence can be noted.
  1 1,839 302
Sub mucous cleft palate with fenestration
Sheerin Shah, Ramneesh Garg, Sanjeev K Uppal, Rajinder K Mittal
September 2014, 4(3):56-57
DOI:10.4103/2229-516X.140745  PMID:25298946
Congenital fenestration in sub mucous cleft palate is not a common identity. This patient is a 16-year-old female who presented with nasal speech. On examination, she had associated microform cleft lip with nasal deformity. Successful palatoplasty with intra velar veloplasty was done.
  1 1,820 239
Composite alginate hydrogel microparticulate delivery system of zidovudine hydrochloride based on counter ion induced aggregation
Harekrishna Roy, P Venkateswar Rao, Sanjay Kumar Panda, Asim Kumar Biswal, Kirti Ranjan Parida, Jharana Dash
September 2014, 4(3):31-36
DOI:10.4103/2229-516X.140728  PMID:25298940
Aim: The present study deals with preparation of zidovudine loaded microparticle by counter ion induced aggregation method. During this study effect of polyacrylates and hypromellose polymers on release study were investigated. Materials and Methods: The ion induced aggregated alginate based microparticles were characterized for surface morphology, particle size analysis, drug entrapment study, in-vitro study, Fourier-transform infrared (FTIR) spectroscopy, and differential scanning calorimetry (DSC) study. Results and Discussion: The result showed Eudragit RL-100 (ERL) based formulations had smoother surface as well as their mean particle sizes were found greater compared with Eudragit RS-100 (ERS) microparticles. Furthermore, drug entrapments were found to be more in ERL formulae as compared with ERS. RL3 released 101.05% drug over a period of 8 th h and followed Higuchi profile and Fickian diffusion. Moreover, data obtained illustrated that, higher amount of quaternary ammonium group, alkali value, and glass transition temperature may be possible reason for improving permeability of ERL based formulations. It was also noticed, hyroxypropyl methylcellulose (HPMC) K4M premium grade polymer sustained drug release more than HPMC K15M. In addition, drug-excipient interaction study was carried out by FTIR and DSC study.
  1 2,203 327
Eventration of diaphragm with dextrocardia and type 2 respiratory failure: A rare entity
Mohmad Hussain Mir, Faheem Arshad, Farhana Siraj Bagdadi, Syed Aejaz Nasir, Mubashir Rashid Hajni
September 2014, 4(3):58-60
DOI:10.4103/2229-516X.140746  PMID:25298947
Eventration of the diaphragm is a rare condition where the muscle is permanently elevated, but retains its continuity and attachments to costal margin. In this condition, all or part of the diaphragm is largely composed of fibrous tissue with a few or no interspersed muscle fibers. It can be complete or partial. It is seldom symptomatic and often requires no treatment. We present a 70-year-old male who came with progressive breathlessness and was admitted with type 2 respiratory failure, and on evaluation was found to have complete eventration of the left diaphragm with herniation of colon and stomach in the left chest with dextrocardia. Aim of reporting this rare case is to highlight the importance of history taking, good physical examination, and imaging in the diagnosis of diaphragmatic eventration.
  - 2,010 226
Extranodal anaplastic large cell lymphoma mimicking sarcoma: A report of an interesting case
Zeeba S Jairajpuri, Safia Rana, Shaan Khetrapal, Majid A Talikoti, Sujata Jetley
September 2014, 4(3):50-52
DOI:10.4103/2229-516X.140741  PMID:25298944
Lymphomas are malignancies of the lymphoid tissues involving cells of the immune system. Primary systemic anaplastic large cell lymphoma (ALCL) represents an aggressive lymphoma characterized by neoplastic proliferation of lymphoid cells with an anaplastic appearance. Large pleomorphic cells are "hallmark" cells with horseshoe-shaped or kidney-shaped nuclei and a constant expression of the CD30 molecule on all neoplastic cells. There is a vast morphological spectrum posing a challenge to pathologists in the diagnosis of ALCL.
  - 2,423 306
Missing data in clinical trials: Pitfalls and remedies
Sandeep Kaushal
September 2014, 4(3):6-7
  - 1,665 811
Prevention and management of type 2 diabetes: Potential role of genomics
Rajiv Mahajan, Kapil Gupta
September 2014, 4(3):1-1
DOI:10.4103/2229-516X.140704  PMID:25298933
  - 1,890 9,250