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   2017| October-December  | Volume 7 | Issue 4  
    Online since December 11, 2017

 
 
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REVIEW ARTICLE
Tumor infiltration depth as a prognostic parameter for nodal metastasis in oral squamous cell carcinoma
Padmaraj Hegde, Satadru Roy, Tripthi Shetty, B Rajendra Prasad, Urvashi Shetty
October-December 2017, 7(4):252-257
DOI:10.4103/ijabmr.IJABMR_66_17  PMID:29308364
Oral squamous cell carcinoma (OSCC) has locoregional evolution, with frequent neck involvement. Significant number of studies have been undertaken to assess the parameters for treatment of N0 neck patients with a high likelihood of harboring occult node metastases. Many studies have indicated tumor infiltration depth (or tumor thickness) as one of the most important criteria in determining the further management. Growing evidence in the literature shows that tumor infiltration depth is a reliable parameter for predicting regional node involvement and patient survival in OSCC. The substantial agreement among authors, despite the lack of comparable study groups, of measurement techniques, and cutoff values paradoxically enforced its reliability. Further studies are clearly awaited to reach a consensus on these topics to develop therapy protocols that are also based on this parameter. This article is an attempt to substantiate the use of tumor infiltration depth as a prognostic factor for nodal metastasis in OSCC.
  1,838 340 1
ORIGINAL ARTICLES
Postoperative analgesia with intravenous paracetamol and dexmedetomidine in laparoscopic cholecystectomy surgeries: A prospective randomized comparative study
Ridhima Sharma, Raghav Gupta, Ripon Choudhary, Sukhminder Jit Singh Bajwa
October-December 2017, 7(4):218-222
DOI:10.4103/ijabmr.IJABMR_25_17  PMID:29308357
Background and Aim: Therapeutic use of nonopioid analgesic such as paracetamol (PCM) is an alternative to opioids, so to avoid the established side effects associated with opioids, PCM is commonly used due to its analgesic and antipyretic effects. Recently, dexmedetomidine has also emerged on the anesthesia front with a potential role of providing postoperative analgesia. The present study was conducted to compare and assess the quality and duration of analgesia with PCM and dexmedetomidine using visual analog scale (VAS). Methods: One hundred patients between the age of 18 and 60 years of the American Society of Anesthesiologists grade I and II undergoing laparoscopic cholecystectomy surgery were randomly allocated into two groups (n = 50). Each patient received either 1 g intravenous PCM, in 100 ml solution before incision (Group I), or i.v. dexmedetomidine 1 μg/kg as bolus over 10 min followed by infusion of 0.5 μg/kg/h (Group II). Postoperatively, the following parameters were observed: quality and duration of analgesia, hemodynamic parameters, time to the first dose of rescue analgesia, sedation, and any postoperative complication or side effects. Statistical analysis was carried out using an unpaired t-test for quantitative parameters and nonparametric data using Wilcoxon signed-rank test and Mann–Whitney U-test. Qualitative data were analyzed using Chi-square or Fishers' exact test. Results: Postoperative analgesic requirement significantly decreased (P = 0.001), with a lower score on VAS, better patient satisfaction scores, and Ramsay Sedation Score ranges from 3 to 5 (62%) in Group I. The incidence of nausea and vomiting, hypotension, and bradycardia was comparable in both the groups except shivering, which was found significantly less in Group II. Conclusion: Incorporation of dexmedetomidine as a part of multimodal analgesia provides better hemodynamic profile, analgesic, sedative, and amnesic properties along with negligible serious adverse effects.
  1,850 277 2
CASE REPORTS
Retinoic acid embryopathy
Dipankar Mondal, Sreekanth R Shenoy, Santisena Mishra
October-December 2017, 7(4):264-265
DOI:10.4103/ijabmr.IJABMR_469_16  PMID:29308367
Isotretinoin is a retinoid which is derived from Vitamin A. It is indicated for severe cystic acne treatment, but it has been classified as teratogenic. A wide spectrum of birth defects including craniofacial, heart, and nervous system malformations have been described with prenatal exposure to this drug. We report the case of a newborn with a history of prenatal exposure to isotretinoin with craniofacial defects, including left-sided anotia, right-sided microtia, complex congenital heart disease, and central nervous system malformation.
  1,766 238 7
ORIGINAL ARTICLES
Influence of Lactobacillus acidophilus and Lactobacillus plantarum on wound healing in male Wistar rats - an experimental study
Anupama M Gudadappanavar, Prashant R Hombal, Somling S Timashetti, SB Javali
October-December 2017, 7(4):233-238
DOI:10.4103/ijabmr.IJABMR_329_16  PMID:29308360
Context and Aim: Probiotics have been documented with various pleotropic effects other than improving general gut health, but the potential benefits of strain-specific Lactobacillus on wound healing are unknown. Hence, the objective of the study is to evaluate and compare the wound healing property of Lactobacillus acidophilus and Lactobacillus plantarum on various wound models in male Wistar rats. Subjects and Methods: Excision wound, resutured incision wound, and dead space wounds were inflicted under light thiopentone anesthesia in male Wistar rats (n = 6, in each group). The rats received one of the Lactobacillus orally as per their weight for a period of 10 days in resutured incision (assessed by wound breaking strength) and dead space wounds (granuloma dry weight, histopathology of granulation tissue, and biochemical hydroxyproline estimation), whereas in excision wounds, treatment was monitored by planimetry. Data were expressed as mean ± standard error of mean and analyzed by ANOVA followed by Tukey's multiple post hoc test. P < 0.05 was considered as statistically significant. Results: L. acidophilus showed a significant difference (P < 0.05) in all the three models, namely, enhanced wound contraction and decreased days for complete epithelization in excision wound; increased breaking strength in resutured incision wound; increased granuloma dry weight and cellular infiltration in granulation tissue with marked increase in collagen content indicating wound healing. Conclusions: The study suggests that the wound healing activity of L. acidophilus if could be extrapolated to clinical situations may decrease dosage and duration of treatment and can be a potential adjuvant to reduce hospitalization with efficient recovery after injury and sustained good health.
  1,737 217 3
Evaluation of risk factors for exchange range hyperbilirubinemia and neurotoxicity in neonates from hilly terrain of India
Deeksha A Singla, Seema Sharma, Milap Sharma, Sanjeev Chaudhary
October-December 2017, 7(4):228-232
DOI:10.4103/ijabmr.IJABMR_298_16  PMID:29308359
Background and Aim: Neonatal hyperbilirubinemia continues to be the most common cause of hospital admissions and readmissions in the neonatal population worldwide and this pattern continues despite attempts to identify neonates at risk of pathological hyperbilirubinemia. Therefore, this study aimed to study the risk factors for severe hyperbilirubinemia in neonates. Materials and Methods: An observational prospective study was undertaken for 1 year in neonates with hyperbilirubinemia requiring double volume exchange transfusion in neonatology unit of a tertiary rural health care hospital. Results: Risk factors included ABO incompatibility in 14 (28.5%), Rh incompatibility in 14 (28%). Other risk factors for hyperbilirubinemia were, jaundice in elder sibling, oxytocin use, birth asphyxia, hypothyroidism, ABO along with Rh incompatibility, Glucose-6 phosphate Dehydrogenase deficiency, cephalhematoma, and sepsis in neonates. Ten (20%) neonates were neurologically abnormal with signs of encephalopathy. Significant association of risk factors with neurotoxicity were also found. All neurologically abnormal neonates were small for date and none was appropriate for date (P = 0.05). There were no neurologically abnormal neonates with A+ and O− mothers (P = 0.04). Conclusion: The high rate of exchange transfusion warrants aggressive management of neonatal hyperbilirubinemia by health-care providers by adequate dissemination of information, strict following of hour-based normograms, performing total serum bilirubin assessment in all icteric neonates, and stratification into risk groups thereafter.
  1,498 210 3
A qualitative and quantitative comparison of adverse drug reaction data in different drug information sources
Gurpreet Kaur Randhawa, Rajeev Sharma, Navyug Raj Singh, Nidhi Sharma
October-December 2017, 7(4):223-227
DOI:10.4103/ijabmr.IJABMR_18_17  PMID:29308358
Background: For safe use of medicines, awareness regarding the existing knowledge of adverse drug reactions (ADRs) is essential to prevent, identify, and manage them. Aim: The present study is planned to assess variation in documented ADRs of antihypertensive drugs in various sources of drug information. Material and Methods: A cross-sectional, observational study was undertaken to analyze the different sources of ADRs-related information. Textbooks, National Formulary India (NFI), Drug Today (DT), and Current Index of Medical Specialties (CIMS) were analyzed for ADRs pertaining to nine antihypertensive groups comprising a total of 44 drugs. ADRs were categorized according to body systems, tabulated, and compared. Quantitative and qualitative analyses of ADRs and serious ADRs were done. Results and Discussion: Textbooks mostly provided ADRs of drug groups as a whole and not of individual drugs. None of the analyzed sources mentioned all antihypertensive drugs. DT contained information for the maximum number of drugs studied (81.8%) and NFI gave information for 29.7% drugs only. There was a wide variability among various resources while listing ADRs. NFI listed the maximum number of total ADRs, and least ADR information was provided by DT. NFI mentioned the maximum number of serious ADRs (47) for prototype drugs followed by CIMS (36) and DT (8). The quality of data was better in NFI, but none of the resources studied were found to be complete. Conclusion: No source of information was complete in providing wholesome information of ADRs studied, and there was a wide variability in describing them.
  1,468 213 -
CASE REPORTS
Gingival-colored porcelain: A clinical report of an esthetic-prosthetic paradigm
Shital Jalandar Sonune, Shiv Kumar, Manish Shivaji Jadhav, Santosh Martande
October-December 2017, 7(4):275-277
DOI:10.4103/ijabmr.IJABMR_405_16  PMID:29308371
Traditionally, periodontics has been instrumental in treating hard- and soft-tissue defect. Surgical and regenerative periodontal procedures can reconstruct the three-dimensional architecture of the hard- and soft-tissue defect. However, at times, these invasive procedures leave the patients with an esthetic problem. In such situations, the defects can be treated by the prosthetic approach. A predictable esthetically pleasing and functional outcome without any surgical procedure is being a choice of treatment for many. This article discusses about the treatment for the defect of excessive hard and soft tissue, using porcelain fused to a metal restoration with gingival-colored porcelain for both tooth-supported and implant-supported fixed prosthesis.
  1,366 183 -
ORIGINAL ARTICLES
Association of glycemic status with bone turnover markers in type 2 diabetes mellitus
Sweta Vilas Kulkarni, Suruthi Meenatchi, R Reeta, Ramasamy Ramesh, AR Srinivasan, C Lenin
October-December 2017, 7(4):247-251
DOI:10.4103/ijabmr.IJABMR_35_17  PMID:29308363
Context: Type 2 diabetes mellitus has profound implications on the skeleton. Even though bone mineral density is increased in type 2 diabetes mellitus patients, they are more prone for fractures. The weakening of bone tissue in type 2 diabetes mellitus can be due to uncontrolled blood sugar levels leading to high levels of bone turnover markers in blood. Aims: The aim of this study is to find the association between glycemic status and bone turnover markers in type 2 diabetes mellitus. Settings and Design: This case–control study was carried out in a tertiary health care hospital. Subjects and Methods: Fifty clinically diagnosed type 2 diabetes mellitus patients in the age group between 30 and 50 years were included as cases. Fifty age- and gender-matched healthy nondiabetics were included as controls. Patients with complications and chronic illness were excluded from the study. Depending on glycated hemoglobin (HbA1c) levels, patients were grouped into uncontrolled (HbA1c >7%, n = 36) and controlled (HbA1c <7%, n = 14) diabetics. Based on duration of diabetes, patients were grouped into newly diagnosed, 1–2 years, 3–5 years, and >5 years. Serum osteocalcin (OC), bone alkaline phosphatase (BAP), acid phosphatase (ACP), and HbA1c levels were estimated. OC/BAP and OC/ACP ratio was calculated. Statistical Analysis Used: Student's t-test, analysis of variance, and Chi-square tests were used for analysis. Receiver operating characteristic (ROC) curve analysis was done for OC/BAP and OC/ACP ratios. Results: Serum OC, HbA1c, and OC/BAP ratio were increased in cases when compared to controls and were statistically significant (P < 0.001). OC/ACP ratio was decreased in type 2 diabetes mellitus and was statistically significant (P = 0.01). In patients with >5-year duration of diabetes, HbA1c level was high and was statistically significant (P < 0.042). BAP levels were high in uncontrolled diabetics but statistically not significant. ROC curve showed OC/BAP ratio better marker than OC/ACP ratio. Conclusions: Uncontrolled type 2 diabetes mellitus affects bone tissue resulting in variations in bone turnover markers. Bone turnover markers are better in predicting recent changes in bone morphology and are cost effective.
  1,294 191 2
CASE REPORTS
Splenic infarction in two members of the family with sickle cell trait: A case report of rare complication
Mithilesh Kumar Sinha, Babita Raghuwanshi, Nerbadyswari Deep Bag, Apurba Barman
October-December 2017, 7(4):272-274
DOI:10.4103/ijabmr.IJABMR_369_16  PMID:29308370
Sickle cell trait is a highly prevalent condition. It is not a disease. However, it has been associated with few rare complications. Splenic infarction is one among them. The altitude-related hypoxia is the most common predisposing factor for this. The simultaneous occurrence of this complication in more than one member of a family is so rare that possibly, it is the only second such case report. We encountered this in two members of a family, the father and his son. They were on a religious visit to a 12,756 feet high mountain cave, when they developed pain left upper abdomen. A thorough workup including contrast-enhanced computed tomography abdomen established the diagnosis. Both recovered uneventfully on the conservative management. As it is a rare occurrence, the finding must be interpreted carefully. There is no need to screen the individuals for sickle cell trait before high-altitude travel.
  1,341 140 2
ORIGINAL ARTICLES
p53 codon 72 gene polymorphism studies and p53 expression by immunohistochemistry in oral lesions as risk factor for malignancy
Nishi Tandon, Anand Narain Srivastava, Naseem Fatima, Syed Tasleem Raza, Vijay Kumar
October-December 2017, 7(4):243-246
DOI:10.4103/ijabmr.IJABMR_205_16  PMID:29308362
Background: Wild-type p53 nuclear phosphoproteins are critical cell cycle regulatory tumor-suppressor gene. Genetic mutation of p53 gene is common in several head–neck cancers, usually associated with smoking and human papillomavirus (HPV) infection. In India, instead of HPV, tobacco/pan masala chewing is more commonly associated with oral cancer. Aim: The aim of this study was to investigate p53 codon 72 gene polymorphism and expression of p53 by immunohistochemistry (IHC) in oral lesions as a risk factor for its association with malignancy. Materials and Methods: A total of 41 cases of oral lesions comprising 6 cases of leukoplakia and 35 cases of oral squamous cell carcinoma (OSCC), between 30 and 60 years age and tobacco/pan masala chewers were taken. Molecular analysis of p53 codon 72 gene polymorphism was performed by polymerase chain reaction – restriction fragment length polymorphism for Arg/Arg, Arg/Pro, and Pro/Pro. Tissue expression of p53 was done by IHC. Results: Genotype frequencies of 35 carcinoma cases of p53 Arg/Arg, Arg/Pro, and Pro/Pro were 23%, 57%, and 20%, respectively, and six leukoplakia cases of p53 Arg/Arg and Arg/Pro genotype were 50% and 50%, respectively. By IHC for expression of p53 out of 35 cases of OSCC biopsies, 17 (48.57%) had weak staining, 14 cases (40%) showed evidence of p53 protein staining, and four cases (11.42%) showed negative staining. Among six cases of leukoplakia, 3 (50%) showed weak staining and 3 (50%) showed negative results. Conclusion: The findings of the study indicate that there is no significant association between p53 codon 72 gene polymorphism with OSCC and leukoplakia associated with tobacco/pan masala chewing.
  1,288 168 -
Piloting direct observation of procedural skills in dental education in India
Gina Singh, Ravleen Kaur, Anushi Mahajan, Abi M Thomas, Tejinder Singh
October-December 2017, 7(4):239-242
DOI:10.4103/ijabmr.IJABMR_54_17  PMID:29308361
Context: Direct observation of procedural skills (DOPS) and corrective feedback are one of the most important tools to promote skill learning. Authentic and pedagogically effective feedback can come out only when based on direct observation of the learners' performance. Use of DOPS, particularly in dental education in India is very uncommon. Aims: To pilot DOPS on undergraduate dental students in the specialty of periodontia. Materials and Methods: The faculty was oriented to the concept and use of this modality during a 1 h session, which included a video demonstration. The generic DOPS recording format with modifications was used for periodontal procedures. A total of 42 procedures (including 7, 30, and 5 of low, average, and high difficulty, respectively) performed by 15 students were observed by four faculty members. Feedback was provided to the students regarding the procedure and how to overcome shortcomings if any. Results: Faculty was comfortable observing and providing feedback (3.95/5.0) and found this mode feasible and nonintrusive in their clinical and teaching schedule. Students expressed satisfaction and acceptance of this modality (4.19/5.0), felt that it would help them in learning skills better (4.01/5.0) and 83% wanted it to be extended to other clinical areas, preferably from the beginning of their clinical postings. Conclusion: DOPS can be incorporated in the in-training assessment of undergraduate dental students and seems to have a good feasibility and acceptability. Faculty training in observation and providing feedback will enhance its utility.
  1,268 143 3
CASE REPORTS
Intravascular papillary endothelial hyperplasia presenting as a cystic mass in the scalp with underlying bone involvement: A rare entity
Anshu Gupta, Sujata Chaturvedi, Karuna Jha, Wazid Nazir
October-December 2017, 7(4):269-271
DOI:10.4103/ijabmr.IJABMR_360_16  PMID:29308369
Intravascular papillary endothelial hyperplasia (IPEH) also known as Masson's hemangioma is a rare benign reactive vascular lesion of the skin and subcutaneous tissue. It is usually confined to the lumen of preexisting vessels/vascular malformations. It is characterized histologically by papillary fronds lined by proliferating endothelial cells. This lesion is often misinterpreted as soft-tissue tumors and other benign and malignant lesions. We present a case of 13-year-old female with IPEH of scalp causing bony defect because of its rarity and diagnostic challenge, it posed due to nonspecific clinical and radiological findings.
  1,257 151 -
A case of oral squamous cell carcinoma in a nontobacco habitué
Karla Maria Carvalho, Poonam Ramnath Sawant, Anita Dhupar, Anita Spadigam
October-December 2017, 7(4):278-280
DOI:10.4103/ijabmr.IJABMR_417_16  PMID:29308372
India is considered to be the oral cancer capital of the world. Oral squamous cell carcinoma is a multifactorial disease with tobacco and alcohol being considered major risk factors. However, there is a growing incidence of nonhabit (i.e., the absence of tobacco or alcohol) associated oral cancer. Difference is noted in demographics, site predilection, grade, and stage while comparing habit associated and nonhabit associated oral carcinoma. This warrants a need for a greater understanding of carcinogenesis without a known carcinogen. This case adds to the sparse existing scientific literature on oral cancer in nonhabitués and reviews the possible etiopathogenic mechanisms underlying the disease process.
  1,216 144 -
A rare long-term complication of physical torture
HK Ranil Sanjeewa, Muditha Vidanapathirana
October-December 2017, 7(4):261-263
DOI:10.4103/ijabmr.IJABMR_14_17  PMID:29308366
The allegations made against custodians regarding ill treatments have been increased in Sri Lanka. However, their attention is grabbed by the immediate complications of torture, but not by late or delayed complications. A 35-year-old male was arrested for alleged housebreaking and kept under police custody. He alleged that he was hanged with his hands on several occasions. Six weeks after the incident, he presented to a tertiary care hospital with the weakness of his right shoulder. Examination revealed hyperpigmented scars over the left wrist and back of the left forearm with the right-sided medial winging of the scapula. He alleged that it had affected his day-to-day life. The presence of hyperpigmented scars over the left wrist and the long-term complications such as winged scapula of the right shoulder corroborated with the alleged history of torture by suspension from the wrists.
  1,203 139 -
Bilateral three-headed biceps brachii muscle and its clinical implications
Sandeep Saluja, Sushant Swaroop Das, Dinesh Kumar, Preeti Goswami
October-December 2017, 7(4):266-268
DOI:10.4103/ijabmr.IJABMR_339_16  PMID:29308368
Biceps brachii muscle frequently exhibits variant morphology in terms of origin, insertion, and mode of innervation. Nevertheless, the three-headed biceps brachii is described to be the most common variation. During routine cadaveric dissection, we came across a unique case of tricipital biceps brachii present on both the sides and variant course and branching pattern of musculocutaneous nerve. The third-headed biceps brachii emerged from the deep investing fascia of the brachialis muscle on both the sides. The musculocutaneous nerve (MCN) did not pierce the coracobrachialis muscle on the right side and terminated by supplying the muscles of the anterior compartment of the arm. However, a normal course was pursued by the MCN on the left side. Thus, scrupulous knowledge of the variant morphology of the biceps and associated structures may facilitate preoperative diagnosis and management of the upper limb diseases and circumvent iatrogenic injuries.
  1,206 125 -
Neonatal intramural calcification in jejunal atresia: Case report of a rare phenomenon
S Suchitha, BN Kumarguru, Sunila , GV Manjunath
October-December 2017, 7(4):258-260
DOI:10.4103/ijabmr.IJABMR_267_16  PMID:29308365
Intramural calcification in intestinal atresia is a rare type of intra-abdominal calcification. The exact etiology of intramural calcification remains obscure. A 1-day-old newborn male baby presented with signs of intestinal obstruction and was diagnosed to have jejunal atresia. The newborn underwent laparotomy with resection of atretic and dilated part of the small bowel. Histology of atretic part of jejunum and adjacent area revealed intramural calcification with extensive foreign-body giant cell reaction. This appears to be the first time that intramural calcification has been documented in association with extensive foreign-body giant cell reaction in a case of jejunal atresia. It can be hypothesized that vascular insult is the initiating event. The further consequences could be multifactorial. This could be the reason for the variation in the site of calcific deposits. Intramural calcification with extensive foreign-body giant cell reaction is a rare phenomenon and calls for focused studies aiming at elucidating the exact etiopathogenesis of intramural calcification.
  1,100 134 -
EDITORIAL
Inclusion of medical colleges as adverse drug reaction monitoring centers under pharmacovigilance programme of India: Missing the targets
Rajiv Mahajan
October-December 2017, 7(4):217-217
DOI:10.4103/ijabmr.IJABMR_342_17  PMID:29308356
  1,042 168 -
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