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   Table of Contents - Current issue
April-June 2021
Volume 11 | Issue 2
Page Nos. 63-127

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International Journal of Applied And Basic Medical Research: Decade-old journey of journal p. 63
Rajiv Mahajan
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A cross-sectional study of knowledge, attitude, and practice toward breastfeeding among postnatal mothers delivering at a tertiary care center in Garhwal, India Highly accessed article p. 64
Rakesh Kumar, Rajlaxmi Mundhra
Background: Despite several initiatives taken, exclusive breastfeeding rates remain low. The objective of this study was to evaluate the knowledge, attitude, and practices of breastfeeding and to assess factors associated with breastfeeding practices among postnatal mothers delivering in Garhwal region of Uttarakhand, India. Methods: A cross-sectional study was conducted from March 2018 to August 2018 among postpartum mothers who were selected through convenient nonrandom sampling. A semi-structured questionnaire including the participants' data, knowledge, attitude, and practices was used. Results: A total of 361 postnatal mothers participated in the study. 88.92% knew that breastfeeding should be continued for 6 months after birth and almost 64.81% initiated breastfeeding within 1 h of birth. 26.59% of the women discarded colostrum. 16.35% of the mothers gave prelacteal feeds, with formula milk being the most common prelacteal feed. 82.82% of the mothers did not receive breastfeeding counseling during antenatal visits. Multiparous women, those undergoing vaginal delivery (VD), and those living in joint family were more likely to initiate breastfeeding within 1 h of birth as compared to primiparous women, those undergoing cesarean section, and those living with nuclear families (P < 0.05). A significant difference was also noted in terms of giving prelacteal feeds in those undergoing cesarean section as compared to VD (23.71% vs. 13.63%, P = 0.0217). Conclusion: This study revealed that the rate of early initiation of breastfeeding is still low.
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Enzymatic protein hydrolysates, and ultrafiltered peptide fractions from two molluscs: Tympanotonus fuscatus var. radula (L.) and Pachymelania aurita (M.), with angiotensin-I-converting enzyme inhibitory and DPPH radical scavenging activities Highly accessed article p. 70
Abraham Abbey Paul, Queensley Adesuwa Eghianruwa, Olayemi Grace Oparinde, Adetunji Samuel Adesina, Omolaja Osoniyi
Context: Multifunctional food protein-derived peptides attract a great deal of research interest due to their health-promoting benefits. Particularly, peptides that have both antihypertensive and antioxidant properties are desired, since both effects can be synergistic in prevention of cardiovascular diseases. Aim: The aim of this study was to investigate the angiotensin-I-converting enzyme (ACE) inhibitory and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activities of two species of the Nigerian periwinkles: Pachymelania aurita and Tympanotonus fuscatus. Methods: The ACE inhibitory and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activities of simulated gastrointestinal digestion (SGID) hydrolysates and ultrafiltered (UF) fractions of T. fuscatus var. radula and P. aurita were determined. Human SGID of the protein extracts of T. fuscatus and P. aurita was carried out using pepsin, trypsin, and chymotrypsin, and the hydrolysates were fractionated into two by centrifugal ultrafiltration. The ACE inhibitory and DPPH radical scavenging activities of the crude hydrolysates and UF fractions were tested. The UF permeates were observed to have relatively higher activities and was subjected to gel filtration chromatography on Sephadex G-50. The chromatographic fractions showed absorbance at 215, 225, and 280 nm and were assayed for DPPH radical scavenging activity. Results: The inhibitory effect of the fractions on ACE activity was reported as the minimum concentration of extract that caused 50% of the inhibition (IC50), where the IC50 values of P. aurita UF permeate and P. aurita UF retentate were 65.2 ± 6.4 and 301.9 ± 59.1 μg/ml, respectively, and that of T. fuscatus UF permeate (TFUFP) and T. fuscatus UF retentate were 54.93 ± 2.83 and 291.7 ± 8.6 μg/ml, respectively. Conclusion: This study suggests the potential health benefits of consuming T. fuscatus var. radula and P. aurita in health maintenance.
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Comparison between allogenic and xenogenic bone blocks on the osteogenic potential of cultured human periodontal ligament stem cells: Confocal laser and scanning electron microscopy study p. 75
Areej Hussein Mukhtar, Montaser N Alqutub
Aim: The aim of this study was to compare between equine and human bone blocks in the osteogenic differentiation of cultured human periodontal ligament stem cells (hPDLSCs) at 14 and 21 days of culture, using confocal laser microscopy and scanning electron microscopy. Materials and Methods: In vitro cultures of commercially obtained hPDLSCs were seeded onto equine and human bone blocks. At 14 days and 21 days of culture, confocal laser microscope images were obtained to assess cellular differentiation and adhesion, and scanning electron microscope images were obtained to validate the osteogenic differentiation by showing the morphological characteristics of the new bone cells. Results: Both equine and human bone blocks showed positive staining for newly formed bone cells through the confocal laser microscope analysis, however, a higher signal intensity was expressed at 21 days of culture. These findings indicate the biocompatibility of hPDLSC with both types of bone blocks, cellular differentiation, and adhesion. Scanning electron microscopy images validated the osteogenic differentiation by showing the common characteristics of bone cells as flattened, polygonal morphology with multiple extending cytoplasmic processes. Conclusion: Both equine and human bone blocks were able to confirm the osteogenic capability of seeded human PDLSC. There was no significant difference between equine and human bone blocks on the human PDLSC differentiation. Superior osteogenic differentiation of cultured hPDLSCs was evident at 21 days in comparison to 14 days.
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Outcome of trabeculectomy with collagen matrix implant versus mitomycin C in primary glaucoma: A comparative study p. 80
Ashok K Sharma, Palak Gupta, Hans Raj Sharma
Background: Glaucoma is a serious vision-threatening condition appropriately called as the silent killer of sight. The effect of postoperative fibrosis on success of filtration surgeries requires modulation of the wound healing process. Aim: The aim of the study was to compare trabeculectomy augmented with collagen matrix implant with mitomycin C in primary glaucoma. Materials and Methods: This prospective, longitudinal, hospital-based, analytical, and interventional study was conducted on 36 eyes of 36 patients. Group 1 included 18 patients who underwent trabeculectomy combined with subconjunctival collagen matrix implant and Group 2 included 18 patients who underwent trabeculectomy augmented with intraoperative mitomycin C (0.04 mg/ml) for 2 min. Each patient underwent detailed ocular examination and comparison was drawn by recording intraocular pressure (IOP), bleb characteristics, and postoperative complications. Results: The cumulative success rates at the end of our study were similar in two groups, 94.44% in Group 1 and 88.89% in Group 2 (P = 1.000). The mean reduction in IOP at 24 weeks in Group 1 was 18.67 ± 7.59 mmHg and in Group 2 was 21.32 ± 5.84 mmHg. The reduction in IOP was similar between the two groups (P = 0.290). The mean fall in IOP was 56.46% in Group 1 and 64.70% in Group 2 at 24 weeks. Mean bleb score in Group 1 was 10.33 ± 1.23 and in Group 2 was 8.89 ± 1.41, and the difference was statistically significant (P = 0.002). Shallow anterior chamber, overfiltration, and hypotony were statistically higher in Group 2 than in Group 1 (P = 0.041, 0.041, and 0.046, respectively). Conclusion: Collagen matrix implant as an adjuvant to trabeculectomy is noble, safe, and effective option as compared to mitomycin C.
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Evaluation of the institutional educational environment by using the dundee ready educational environment measure p. 85
Manraj Kaur, Tanvir Kaur Sidhu, Rajiv Mahajan, Prabhjot Kaur
Background: Evaluation of the educational climate has been highlighted as key to the delivery of high-quality medical education. Health educators across places and educational settings have widely used the Dundee Ready Educational Environment Measure (DREEM) to appraise their institutions' educational climate. Objectives: The aim is to assess the educational environment of our Institution and to find the association with the related variables. Methodology: Institution-based cross-sectional study was conducted using the DREEM questionnaire enrolling 527 MBBS undergraduate students. Results: An inclination toward a positive environment was found in our institution, which has statistical significant association with the phase of training of the students. Conclusion: Positive educational environment was found in our institution. This suggests reinforcement of positive practices and scope for improvement in certain other areas.
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Evaluation of anti-plaque and anti-inflammatory effects of oral curcumin gel as adjunct to scaling and root planing: A clinical study p. 90

Context: The adverse effects associated with traditional adjunctive chemical agents in the management of gingivitis has stimulated research into search for alternate molecules including herbal products. Aims-To compare the effects of oral curcumin gel as an adjunct to scaling and root planing (SRP) with the effects achieved by SRP alone by assessing their effects on plaque, gingival inflammation and gingival bleeding. Materials and Methods: Sixty patients in the age group of 20–60 years were recruited employing inclusion and exclusion criteria. Study population was randomly divided into two groups. Group A-test group was instructed to use twice daily the experimental curcumin gel after initial SRP. Group B-control group received only SRP. Parameters recorded were plaque index (PI), gingival index (GI) and sulcus bleeding index (SBI) on day 0 (baseline), days 7, 14, and 21 along with subjective assessment of any reported untoward side effect. Data was analyzed statistically. Results: The PI, GI and SBI decreased in both the test group and control group from day 0 to day 21 consecutively. Intergroup comparison shows that all the parameters were statistically significant in Group A (P < 0.001) as compared to Group B. Conclusion: Curcumin gel has significant antiplaque and anti-inflammatory effect in the treatment of gingivitis and can be effectively employed as an adjunct to SRP.
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Biomarker potential of preoperative tumor size in determination of the lymphovascular invasion in squamous cell lung cancer and lung adenocarcinoma p. 95
Kemal Grbic, Aida Mujakovic, Orhan Lepara, Zahid Lepara, Edin Begic, Ferid Krupic
Introduction: The invasion of blood and lymph vessels with tumor tissue represents a negative prognostic factor of the disease course in patients with non-small cell lung cancer. Aim: The aim of the study was to determine the marker value of a preoperatively determined size of pulmonary squamous cell carcinoma and adenocarcinoma and its impact on lymphovascular invasion (LVI) in resected lung tissue. Materials and Methods: The conducted observational cross-sectional study included 322 patients with a complete resection of confirmed squamous cell lung carcinoma and lung adenocarcinoma. Preoperative size and type of tumor were determined by a preoperative chest computed tomography scan and cytological/histological analysis of obtained samples, while LVI status was determined by pathohistological analysis of resected tumor lung tissue. Receiver operating characteristic (ROC) curve analysis was performed to assess whether tumor size could serve as a reliable marker for LVI. P < 0.05 was considered statically significant. Results: A statistically significant difference in the frequency of tumor size (P = 0.580) along with LVI (P = 0.656) was not established between the patients with squamous cell lung cancer and lung adenocarcinoma. A ratio between the size of lung adenocarcinoma and LVI status (P < 0.001) was determined as statistically significant, while such a difference was not established in squamous cell lung cancer (P = 0.052). The ROC analysis revealed that tumor size >39 mm in patients with lung adenocarcinoma has obtained a sensitivity of 70.8% and a specificity of 60.9% to differentiate patients with a LVI (areas under the curve [AUC] = 0.70; 95% CI 0.60‒0.79; P < 0.001). A tumor size >4.6 cm in patients with squamous cell lung cancer obtained a sensitivity of 56.5% and a specificity of 60.3% to differentiate patients with a LVI (AUC = 0.59; 95% CI 0.50‒0.67; P = 0.043). Conclusion: The preoperative size of lung adenocarcinoma could be an acceptable marker of LVI presence in resected lung tissue, while in the squamous cell lung cancer, a potential biomarker role of the preoperative size of the tumor was inadequate.
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Evaluation and comparison of the effect of elastomeric chain and stainless steel ligature wire on maxillary orthodontic miniscrew failure p. 100
Rishi Joshi, Tarulatha Revanappa Shyagali, Ruchi Jha, Abhishek Gupta, Anil Tiwari, Tanvee Tiwari
Context: Orthodontic miniscrews are used for the purpose of conservation of anchorage. Aims: The aim of the study was to evaluate the orthodontic miniscrew failure between the elastomeric chain-supported retraction and stainless steel (SS) ligature-aided retraction. Settings and Design: This was a cross-sectional split mouth randomized controlled trial. Materials and Methods: The sample (30) was divided equally among the control group and the experimental group (15 each). Miniscrews were placed between second premolar and the first molar of maxilla. The experimental group was based on the split mouth technique wherein right or left side of the maxillary arch was treated using either an elastomeric power chain (EPC) engaged to the miniscrews directly (Group 1) or an EPC engaged indirectly to miniscrews with the help of SS ligature wire (Group 2). In control group, implants were placed in maxilla without any retraction force. Clinical signs of inflammation was assessed at the following interval; 7th day, 14th day, 1st month, 2nd month, and at the time of removal of implant. Statistical Analysis Used: Kruskal–Wallis ANOVA test was used. Results: Mean rank of gingival inflammation was 28.33 at the 1st-month interval in Group 1 and inflammation remained high in the this group for all time intervals in comparison to Group 2. Group 2 showed highest mean rank of inflammation of 26.10 at 7th day. In control group, the inflammation remained low at all the time intervals. Moreover, the difference noted was statistically significant. Conclusions: The gingival inflammation around the peri-implant tissue with the application of EPC at various interval remained high in comparison to the EPC with SS group. The gingival inflammation in the control group was very less, and it remained less throughout the different time periods.
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Sliding inguinal hernia in a case of Fournier's gangrene: A rare case p. 106
Meghraj Kundan, Vinaysheel Priyadarshi, Chintamani
Fournier's gangrene and inguinal hernia, both are common diseases. However, inguinal hernia in a case of Fournier's gangrene is rarest of rare cases. Only one such case is reported in literature. We present one such rare case. A 50-year–old man presented with blackish discoloration of scrotum with inguinoscrotal swelling. It was associated with pus discharge and foul smell. There were noassociated co morbidities. The patient was a chronic smoker from 40 years. Serial debridement was done until the wound became healthy and free of infection. After infection control, the patient was operated and hernioplasty was done.
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Successful laparoscopic myomectomy in giant myoma p. 108
Vikas Devkare, Meenakshi Gothwal
A giant uterine fibroid is a rare tumor of the uterus. Uterine leiomyomas are the most common type of a benign tumor that arises from the female pelvis. Uterine leiomyoma is a smooth muscle tumor. Its prevalence is more in reproductive age group and decreases after menopause. They are rare in adolescents. In reproductive age group, the preferred mode of management of fibroid is myomectomy. For large myomas, the role of laparoscopic myomectomy is still controversial. Laparoscopic myomectomy for giant myoma is technically challenging and should be performed by an experienced surgeon. We herein report the case of a 32-year-old unmarried girl who visited our hospital with the complaint of progressive abdominal distension and discomfort from the past 4–5 months. Ultrasonography was done, and it showed a markedly enlarged uterus containing a 16 cm × 17 cm subserosal fibroid and 3 cm × 4 cm intramural fibroid. Magnetic resonance imaging suggestive of three myoma, one sub serosal myoma at fundal region of 11.2 cm × 9.6 cm × 14.2 cm, second intramural fibroid in the lateral wall of the uterus of 3 cm × 3 cm and a small submucosal fibroid of dimension 1.1 cm × 0.9 cm × 0.8 cm. Laparoscopic myomectomy was planned and completed successfully with no intra- and postoperative complications. Intraoperative finding was suggestive of 20 cm × 20 cm × 18 cm fundal fibroid and 2 cm × 3 cm lateral wall fibroid. The defect was closed using V-lock suture in two layers. The myoma was removed by tissue morcellator. In the literature, only a few cases reported of successful removal of giant myoma by laparoscopy.
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Atypical presentation of granular cell tumor involving tongue: A rare case report p. 111
Sudeshna Bagchi, Sanchita Kundu, Arunit Chatterjee, Rudra Prasad Chatterjee
Granular cell tumor (GCT) is a rare benign tumor chiefly affecting the orofacial region, especially tongue. The origin of this neoplasia, after remaining a controversy for years, was finally identified to be from Schwann cell or neuroendocrine cell. They usually present as asymptomatic, firm, sessile, submucosal, solitary, or multiple nodule/papule like lesions. Histopathologically, the presence of sheets, cords or nests of large cells having abundant, eosinophilic granular cytoplasm, and pseudoepitheliomatous hyperplasia are the characteristic features of this neoplasm. Immunohistochemical stains such as S100, Cluster of differentiation 68, neuron-specific enolase, and laminin also aid in the proper diagnosis of granular cells. We hereby present a case of GCT in a 50-year-old male, which had a unique exophytic appearance, probably being only the second to be reported till date.
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Mitochondrial fission factor gene mutation: A dilemma for prenatal diagnosis p. 114
Charu Sharma, Arunima Saini, Meenakshi Gothwal, Manisha Jhirwal, Payal Patwa
Mitochondrial fission factor (MFF) gene mutations are rare mitochondrial fission disorders, resulting in autosomal recessive neurological disorders. We here report a rare case of MFF gene mutation running in a family which ultimately turned out to be a variant of unknown significance. A 29-year-old multigravida visited at 18-week gestation for prenatal genetic testing as her previous baby had cerebral palsy and global developmental delay. The exome sequencing of the affected baby revealed defective mitochondrial and peroxisomal fission 2 (AR-617086). On Sanger sequencing, the mother was homozygous and the father heterozygous for the same variant. In the current pregnancy, amniocentesis was done and the fetus was also homozygous for a similar mutation. The couple continued the pregnancy and delivered a healthy baby who had normal milestones at 11 months of age. As far as prenatal diagnostic testing is considered, our case is a real-world scenario, where patient expectations befuddle appropriate decision-making.
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Sebaceous gland carcinoma of lid: Masquerading as a recurring chalazion p. 117
Sandip Kumar Sahu, Saswati Sen, Chanchal Poddar
Recurrent chalazion may be associated with bad lid hygiene but can have clinical changes which lead to the suspicion of a more dangerous entity. Particularly in elderly patients, recurrence of chalazion should be suspected to have carcinomatous changes. We present the case of a 52-year-old woman with presentation of recurrent chalazion which turned out to be sebaceous gland carcinoma of the lid. Sebaceous gland carcinoma usually presents as a small firm nodule resembling chalazion, and majority of the premalignant and malignant lesions misdiagnosed as chalazion are primary cases. Hence, the need of histopathological examination in every such case cannot be undermined.
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COVID-19: Asymptomatic carrier : An autopsy case report p. 120
Yogender Malik, Kulwant Singh, Sarita Yadav, Yogesh Kumar Vashist, Anil Garg, Sunil Kumar, Gaurav Sharma
The severe acute respiratory syndrome (SARS)-coronavirus- 2 (CoV-2) outbreak in Wuhan, China has now spread to many countries across the world including the India with an increasing death toll. On March 11, 2020, the new clinical condition COVID-19 (Corona-Virus-Disease-19) was declared a pandemic by the World Health Organization (WHO). Owing to its infectivity, high risk of transmission, and limited handling of dead bodies, published data on the course of diseases has been limited. Most patients with COVID-19 have a mild disease course and remain as asymptomatic carrier; however, few patients of older age and with co-morbidites develop severe disease leading on to fatality. If due to COVID-19 infection death occurs, an autopsy is unlikely. However in unnatural deaths the legal duty impels the proper performance of a full autopsy, to find out the cause and manner of death. The detailed autopsy examination along with histo-pathological findings in the organs of asymptomatic patient of COVID-19 and its comparison with microscopic findings in Aluminium Phosphide poisoning are discussed below. This will summarizes the research status for COVID-19 deaths, which will be important for evaluation of cause of death, prevention, control and clinical strategies of COVID-19.
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Principles of medical education: A review of Book's fifth edition p. 125
Medha Anant Joshi
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