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   Table of Contents - Current issue
October-December 2020
Volume 10 | Issue 4
Page Nos. 223-297

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Workplace-based assessment: A valuable tool in undergraduate dental education p. 223
Eswara Uma
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Lung pathology in COVID-19: A systematic review Highly accessed article p. 226
Pinki Pandey, Savita Agarwal, Rajkumar
Sparse literature is available regarding autopsy findings of coronavirus disease 2019 (COVID-19) despite high mortality due to its highly contagious nature and lack of robust infrastructure for appropriate handling of the infected cases. Based on clinical findings and various diagnostic tests, it is evident that it holds the potential to affect multiple organ systems of the body preferably lungs and immune and coagulation systems. Cytokine storm-induced thrombotic complication such as disseminated intravascular coagulation is a significant feature in severe cases of COVID-19. This review captures the current information on lung histopathology in COVID-19 infection and severe respiratory failure. In COVID-19, lungs are affected bilaterally, become edematous and red/tan mottled to maroon in color with firm consistency. Distinct parenchymal changes, firm thrombi in the peripheral pulmonary vessels along with diffuse alveolar damage, have been the most consistent feature of COVID-19-related lung pathology. Electron microscopy has also been used to demonstrate viral particles.
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Molecular detection of fusion oncogenes in zambian patients with acute lymphoblastic leukemia p. 234
Pauline Okuku, Geoffrey Kwenda, Mulemba Samutela, Panji Nkhoma, Hamakwa Mantina
Introduction: Chromosomal aberrations play a significant role in the pathogenesis of acute lymphoblastic leukemia (ALL) with prognostic and therapeutic implications. Despite the availability of molecular tools, low-resource settings struggle to diagnose the disease due to limited diagnostic capacity. The objective of this study was to detect common chromosomal aberrations in patients with ALL attending the University Teaching Hospital (UTH) in Lusaka, Zambia. Materials and Methods: In this prospective study, 19 blood samples from patients with ALL were screened for the presence of BCR-ABL, E2A-PBX1, MLL-AF4, and ETV6-RUNX1 fusion oncogenes using reverse transcriptase-polymerase chain reaction assay. Blood counts and clinical characteristics of patients were also assessed. Results: The age of patients ranged from 1½ to 72 years and comprised 57.9% of males and 42.1% of females. The majority of these patients were children (68%), and adults only comprised 32%. Only BCR-ABL and E2A-PBX1 oncogenes were detected in 3/19 of cases. The BCR-ABL gene was detected in a 4-year-old female child and a 15-year-old child. Both cases were associated with hepatomegaly and anemia coupled with low hemoglobin, white blood cell, and platelet counts. E2A-PBX1 was detected in a 12-year-old child with lymphadenopathy and splenomegaly, coupled with low hemoglobin, white blood cell, and platelet counts. All the three patients who harbored these fusion oncogenes died. Conclusion: This is the first study from Zambia to investigate the presence of fusion oncogenes in leukemia patients, which were found only among the older children population. Based on these findings, we recommend that molecular diagnosis be made a priority for the younger leukemia patient population at UTH.
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Comparative study on different hormones between normal pregnant women and women experiencing miscarriage p. 240
Prithvi Bahadur Shah, Kapil Gupta, Mini Bedi
Background: Pregnancy leads to a complex alteration in hormonal levels and metabolism in the maternal and fetal system and if undesirable alteration is experienced, complications may be seen. Common complications of pregnancy include gestational diabetes, preeclampsia, preterm labor, and pregnancy loss or miscarriage. Miscarriage is defined as a spontaneous pregnancy loss occurring before 20 weeks of gestation. It has been seen in around 10%–15% of clinically recognized pregnancies. Aim: This study was designed to evaluate the levels of different serum hormones between cases and controls group. Materials and Methods: Pregnant women before 20 weeks of gestation were selected based on inclusion and exclusion criteria, visiting Adesh hospital Bathinda. After recording the history, blood was drawn and serum thyroid-stimulating hormones (TSH), total tri-iodothyronine (TT3), total thyroxine (TT4), prolactin and beta-human chorionic gonadotropin (β-hCG) were analyzed using TSOSH automated immunoassay analyzer. Results: Overall data and data of the 1st trimester suggested significant differences in the mean level of serum TT3, TSH, β-hCG, and prolactin between controls and cases (P ≤ 0.05). However, serum TT4 did not show a significant difference (P > 0.05). In 2nd-trimester significant difference in the mean level of serum TSH was only observed between controls and cases (P ≤ 0.05). Similarly, after applying Pearson's correlation, an inverse relation was only observed between serum TT3 and TSH of both control and cases (P ≤ 0.05). Conclusion: This study emphasized that screening of women during pregnancy for different serum hormones may provide useful lead about the fate of pregnancy and better understanding of different hormones may reduce the rate of miscarriages and other complications related to pregnancy.
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Status of serum prolactin levels among male cohort in infertile couples p. 245
Kinikanwo I Green, Collins Amadi
Background: Abnormalities of serum prolactin adversely impact the reproductive functions among infertile men. Hence, this study was aimed to determine the influence of prolactin abnormalities on gonadal functions of male cohorts of infertile unions in Port Harcourt, Nigeria. Methods: This was a retrospective survey of 1845 males of infertile unions who presented in a health-care facility for reproductive endocrine evaluation following abnormal semen parameters between 2007 and 2018. The demographic, clinical, and laboratory variables were evaluated among study cohorts. Results: Hyperprolactinemia was observed in 16.7% of the study cohorts with 9.6%, 5.0%, and 2.1% of mild, moderate, and severe grades, respectively. The hyperprolactinemic cohorts had depressed levels of follicle-stimulating hormone (FSH), luteinizing hormones (LH), and total testosterone (TT) which worsened further with worsening grades of hyperprolactinemia. Inverse relationship of prolactin levels existed with FSH (crude β: −0.651; P < 0.001; adjusted β: −0.666; P < 0.001), LH (crude β: −0.481; P < 0.001; adjusted β: −0.536; P < 0.001), and TT (crude β: −0.525; P < 0.001; adjusted β: −0.546; P < 0.001) in crude analysis and amplified on age and body mass index (BMI) adjustment. The greatest risk of depressive impact of hyperprolactinemia was on serum TT (crude hazard ratio [HR]: 35.185; P < 0.001; age and BMI-adjusted HR: 35.086; P < 0.001). Erectile dysfunction (ED) was the single most isolated sexual abnormality (n = 111; 35.6%) recorded among the general hyperprolactinemics; however, the ED was specifically more prevalent (n = 15; 38.5%) among the severely hyperprolactinemics. Conclusion: The present study revealed a high frequency of hyperprolactinemia among studied participants. Since the hyperprolactinemia was associated with a large number of cases with other endocrine and sexual dysfunctions, diagnostic and treatment protocols should include prolactin measurement and management during infertility evaluation in males.
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Homeostatic Model Assessment of Insulin Activity and Iron Profile among Regular Blood Donors at a Tertiary Health Centre, South-West Nigeria p. 252
Waliu Olatunbosun Oladosu, Akpojumayenrenne Lawretta Onwah, Rashidat Oluwatosin Oladosu-Olayiwola, Abdullahi Ahmed, Medinat Omobola Osinubi, Olabisi Abosede Gbotosho, Adekunle Bashiru Okesina
Context: Iron overload has been established to play a role in the etiopathogenesis of Type 2 diabetes mellitus (DM) as evidenced by its high prevalence among patients with hemochromatosis and transfusion-dependent diseases. This is as a result of iron redox reaction which generates free radicals that cause peroxidation of lipid-rich pancreas, leading to reduced insulin sensitivity. Aims: This study therefore evaluated the impact of regular blood donation, an effective method of reducing iron load, on β-islet cell functions and level of glycemic control among regular whole blood donors. Settings and Design: This is a cross-sectional, analytical study. Subjects and Methods: Forty-two consenting regular blood donors who had donated whole blood at least twice and not more than thrice in the last 1 year were selected as cases, while 42 age-matched individuals who have never donated blood previously were selected as controls. Samples were obtained and analyzed for fasting plasma glucose, fasting plasma insulin, serum ferritin, transferrin receptor, total iron-binding capacity (TIBC), and serum iron, while Homeostatic Model Assessment (HOMA) of insulin resistance (IR) and beta sensitivity, HOMA-IR, and HOMA-β-cell function (HOMA-β%) were calculated for both groups. Statistical Analysis Used: Statistical analysis was done using Microsoft Excel package and the Statistical Package for the Social Sciences (SPSS) version 20.0 (SPSS Inc., Chicago, IL, USA). Results: Iron studies among regular blood donors and nondonors revealed lower serum iron (37.2 ± 7.3 vs. 41.1 ± 7.9 μmol/L, P = 0.180) and lower serum ferritin levels (30.2 ± 26.1 vs. 42.9 ± 38.5 ng/mL, P = 0.117), which were not statistically significant, while there were higher serum transferrin receptor (155.5 ± 22.6 vs. 112.8 ± 43.4 ng/mL, P < 0.001) and higher serum TIBC (42.3 ± 6.4 vs. 37.8 ± 7.4 μmol/L, P < 0.05), among cases than controls. The mean HOMA-IR and HOMA-β% were also significantly better among donors than nondonors. Conclusions: Regular blood donation may protect the body from the toxic effects of excessive iron store, which includes improved insulin sensitivity and glycemic control.
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Ultrasonographic assessment of diaphragmatic excursion and its correlation with spirometry in chronic obstructive pulmonary disease patients p. 256
Mahvish Qaiser, Nahid Khan, Abhinav Jain
Introduction: Chronic obstructive pulmonary disease (COPD) is a common disease. Spirometry is a standard method of assessment of severity of COPD. We evaluate utility of diaphragmatic excursion using ultrasonography in COPD patients and compare this technique with spirometry. Methods: Twenty-six COPD patients and 18 self-reported healthy controls were included in this study. After taking the sociodemographic data, measurement of diaphragm excursion was done using M-mode and B-mode ultrasound. Lung function was assessed by spirometry. Results: In the COPD group, diaphragmatic excursion was found to be reduced, and it correlates with forced expiratory volume in 1 s (FEV1)/forced vital capacity, whereas it did not correlate with FEV1. Conclusion: Ultrasound assessment of diaphragmatic excursion is an easy, noninvasive, and readily available diagnostic tool and correlates with spirometry in estimation of severity of COPD.
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Efficacy, safety, and cost evaluation of the topical luliconazole therapy versus topical clotrimazole therapy in patients with localized dermatophytosis in a tertiary care hospital: An observational study p. 260
Mandeep Kaur, Anu Gupta, Rajiv Mahajan, Manharan Gill
Background: Dermatophytosis is a superficial fungal infection that has high affinity for keratinized tissues of the body. The treatment of localized dermatophytosis is a major concern for the dermatologist especially in tropical countries like India. Various topical antifungals are available for the treatment of localized uncomplicated dermatophytosis. Luliconazole is an azole antifungal available that has potent activity against dermatophytes. Objectives: The objective of this study was to compare two treatment modalities for the treatment of localized dermatophytosis in terms of efficacy, safety, and cost evaluation. Materials and Methods: This was a prospective and observational study carried out for 6 months and included 200 patients (luliconazole group [n = 94] and clotrimazole group [n = 106]). Patients were followed up for 2, 4, and 6 weeks. Outcome parameters such as pruritis, erythema, scaling, vesiculations, and global assessment score were noted at 2, 4, and 6 weeks for the assessment of efficacy. The statistical analysis was done using Chi-square and Student's t-test. Results: Luliconazole and clotrimazole showed 56.38% and 23.58% cure rate at the end of two weeks respectively (P < 0.05). At the end of treatment, the cure rates were 98.93% and 95.28% in luliconazole and clotrimazole, respectively (P > 0.005). Both the drugs were equally safe. On cost-effective analysis, luliconazole was found to be more cost-effective than clotrimazole at the end of 2 weeks. Conclusion: Therapeutic efficacy of luliconazole was more as significant proportion of patients achieved complete clearance of lesions at faster rate within 2 weeks with convenient once daily application.
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Prognostic role of B-type natriuretic peptide in adults with acute dyspnea requiring emergency admission p. 265
Abhishek Goyal, Anil Kumar Kashyap, Vipin Goyal, Gautam Ahluwalia, Gurbhej Singh, Bhupinder Singh, Rohit Tandon, Shibba T Chhabra, Naved Aslam, Bishav Mohan, Gurpreet S Wander
Objective: The aim of the study was to evaluate the role of B-type natriuretic peptide (BNP) in patients presenting with acute dyspnea admitted in emergency services. Materials and Methods: A prospective observational study was conducted on 100 patients presenting to the emergency of Dayanand Medical College and Hospital and Hero DMC Heart Institute with acute dyspnea of <48 h duration, in which BNP levels were done on arrival to emergency. Results: BNP levels were significantly higher in patients having left ventricular dysfunction, both systolic and diastolic. Patients with systolic dysfunction had slightly higher BNP (1251.50 ±950.14 pg/mL) compared to patients with diastolic dysfunction (905.62±618.10 pg/mL) though statistically insignificant (P = 0.055). BNP levels were also inversely related to ejection fraction. Mean BNP levels in patients with EF <31%, 31%–45%, 46%–59%, and ≥60% were 1464.63 ± 1058.29, 968.24 ± 751.59, 841.64 ± 503.41 and 781.67 ± 504.21 (P = 0.009), respectively. Patients having higher BNP levels had significantly prolonged duration of stay compared to patients with lower BNP. Patients who expired had slightly higher levels of BNP though statistically nonsignificant. BNP had no significant statistical relation with age, heart rate, creatine phosphokinase-MB, Trop-T levels, systolic blood pressure. Conclusion: We conclude that high BNP levels are a marker of cardiac dysfunction and increased duration of hospital stay in patients presenting to the emergency with acute dyspnea. Hence, BNP can be used as a screening test for the evaluation and management of dyspnea.
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Prevalence of psychological distress among undergraduate medical students: A cross-sectional study p. 270
Pradeep Kumar Sahu, Bijoor Shivananda Nayak, Vincent Rodrigues, Srikanth Umakanthan
Background: Stressful environment in medical school often has a negative effect on students' psychosocial well-being. An in-depth understanding of how medical students experience psychological distress and coping is necessary for the prospective students. Objectives: To estimate the prevalence of psychological distress among undergraduate medical students and its association with some demographic factors. Materials and Methods: A cross-sectional descriptive study was conducted among 380 medical students in the University of the West Indies, Saint Augustine. The questionnaires used in this study consisted of two components – (i) the demographic information that required participants to provide their gender, age, year of study, and nationality and (ii) Depression, Anxiety, and Stress Scale-21 items to measure the levels of psychological distress among participants. Results: Anxiety was the most prevalent psychological distress among medical students, with 63% of them having anxiety symptoms. Depression was found to be the second most common psychological distress, with a prevalence of 51%, while 48% of the students suffered from stress. In further analysis, we found that Trinbagonian students were more depressed than the students from Caribbean Community and other nationality. Higher anxiety score was significantly associated with gender and age of the students. There was a significant association between students from different age groups and level of stress. Conclusions: A considerable number of students studying medicine are suffering from psychological distress. Intervention programs to address the mental health problems of such students should be initiated.
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A cross-sectional study to evaluate cardiovascular risk score in type 2 diabetes mellitus p. 276
Arshiya Sehgal, RP S Sibia, Jasleen Kaur, Ena Bhajni, Vijay Kumar Sehgal
Background: Cardiovascular disease is the leading cause of mortality worldwide, including in low- and middle-income countries. Cardiovascular risk assessment is essential to prevent the mortality caused by diabetes. Aim: The current study was conducted to assess the prevalence of cardiovascular risk factors in type 2 diabetes and to compare the United Kingdom Prospective Diabetes Study (UKPDS) and World Health Organization (WHO)/International Society of Hypertension (ISH) chart in assessing cardiovascular risk score. Materials and Methods: Cardiac risk assessments were done in fifty patients attending the medicine outpatient department in an institutional hospital after ethical clearance and taking informed consent from patients. Two assessment tools were applied on the same patient. Results: Overall, 10% of people were obese (body mass index >30). Smoking was prevalent in 20% (10/50) of patients. Hypertension was observed in 60% (30/50) of patients. Raised total cholesterol (TC) was the most common lipid abnormality affecting 94% of patients. The WHO/ISH prediction charts identified 14% and 10% of patients with cardiovascular risk category <10 and 10–20, whereas the UKPDS engine predicted 24% and 38% in the same category. In high-risk categories 30–40 and >40, the WHO/ISH score predicted a higher proportion of patients (18% and 32%) than the UKPDS engine (8% and 4%, respectively). Kappa value was calculated to calculate the degree of agreement between two tools, and it was found to be 0.781 (P < 0.01). Conclusion: Raised TC and hypertension were the most prevalent risk factors. There was no significant discrepancy between two assessment tools in predicting cardiovascular risk score among type 2 diabetes mellitus patients in our study.
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Indications and determinants of cesarean section: A cross-sectional study p. 280
Neetu Singh, Yasodhara Pradeep, Sugandha Jauhari
Background: Cesarean section is one of the most commonly performed surgeries in obstetric practice for saving the lives of women and their newborns from pregnancy- and childbirth-related complications. Its prevalence has increased alarmingly in the last few years, which has motivated this research to identify the indications and determinants, influencing cesarean section delivery in the study area and determine the associated correlates for emergency and elective cesarean sections. Materials and Methods: This was a hospital-based cross-sectional study conducted at a tertiary care center from April 2019 to September 2019. A quantitative tool was designed to capture all the relevant information regarding sociodemographic factors, obstetric characteristics, and indications of cesarean section among the pregnant women delivering at the tertiary care center. Results: A total of 150 women with cesarean deliveries were included in this study. The percentage of primigravida women was significantly higher among emergency than elective cesarean section (χ2 = 28.19, P = 0.0001). Majority of the women were illiterate or had primary education in emergency cesarean section than elective (χ2 = 44.9691, P = 0.0001). Majority of the women with no or only one antenatal visit underwent emergency than elective cesarean sections (χ2 = 42.2195, P = 0.0001). Those females who presented with previous Lower Segment Cesarean Section (LSCS) had greater chances of elective cesarean section, and it was statistically significant (P = 0.004). Conclusion: The increase in cesarean section rate causes burden to the general health system and also strain on the family members. Hence, caution should be exercised in decision-making to perform cesarean section, especially for primigravida, and a comprehensive evidence-based approach needs to monitor the indication of cesarean section.
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A rare presentation of posterior reversible encephalopathy syndrome in recovery phase of guillain–Barré syndrome p. 286
Sham Lohiya, Sachin Damke, Bhavana Lakhkar, Richa Choudhary
Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome, in which a patient presents with neurological symptoms, including headache, seizures, altered sensorium, and loss of vision, and accompanied with characteristic magnetic resonance imaging findings which are likely to be reversible. Guillain–Barré syndrome (GBS) is an acute demyelinating polyneuropathy presumably related to immunological mechanisms. Here, we describe a patient who had PRES in recovery phase of GBS while he was neither on any immunomodulator nor was having hypertension. He recovered completely clinically as well as radiologically.
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“YoYo” ball in heart: Uncommon cause of dyspnea in an elderly female p. 289
Akshyaya Pradhan, Vikas Gupta, Pravesh Vishwakarma, Rishi Sethi
Atrial myxomas are the most common primary tumors of the heart. Their presentation will vary depending on their anatomical site and many times remain asymptomatic. Local obstruction to atrial outflow can present with dyspnea, orthopnea, syncope, and rarely sudden death. A differential diagnosis of tumor in the left atrium includes thrombus. Echocardiography usually suffices in making a diagnosis, but in difficult cases, cardiac computed tomography and magnetic resonance imaging may be needed. We report a case of left atrial myxoma in an elderly female which was asymptomatic and presented with rapid deterioration of symptoms.
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Acute myocardial infarction as the initial presentation of behcet's syndrome p. 292
Parminder Singh Manghera, Akshyaya Pradhan, Jyoti Bajpai, Rishi Sethi
Behcet's disease (BD) is clinically characterized by recurrent oral and genital ulcers and ocular symptoms. However, systemic manifestations involving the lungs, gastrointestinal tract, kidneys, and heart are well known. Acute myocardial infarction (MI) is a rare manifestation of Behcet's syndrome and usually results from coronary arteries vasculitis, leading to aneurysms. More uncommon is the occurrence of acute MI as the initial presenting symptom. Hereby, we report a case of a young male who presented with acute anterior wall MI sans any other conventional risk factors with a normal angiogram. And 3 years later, he was diagnosed with BD.
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Gender and prevalence of dengue fever p. 295
Beuy Joob, Viroj Wiwanitkit
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Humanities in medical education p. 296
Avinash Supe
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