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   Table of Contents - Current issue
July-September 2017
Volume 4 | Issue 3
Page Nos. 161-227

Online since Thursday, July 13, 2017

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Gestational diabetes mellitus: A diagnostic dilemma Highly accessed article p. 161
Rakesh Agarwal, Rashmi Baid
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Despite decades of research and debate, confusion regarding screening and diagnostic criteria for GDM has been persistent. Despite initially been touted as the diagnostic criteria of choice, the Diabetes in Pregnancy Study Group India criteria themselves have been fraught with controversy. We review the disease and its history in brief with a timeline of different criteria proposed for its diagnosis which have only but added to dilemma in its diagnosis.
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Knowledge base and practice among clinicians regarding oral anticoagulant therapy: A questionnaire survey p. 166
JD David Livingston, M Joseph John
Purpose: To assess the knowledge of clinicians regarding various aspects of anticoagulant therapy. Materials and Methods: This cross-sectional study was done over 2 months among 55 clinicians at a tertiary hospital. A 30 point questionnaire based survey on various aspects of oral anticoagulant therapy was carried out. Clinician practices were also compared between physicians and surgeons. Results: Two thirds (67.3%) of the clinicians were not aware that different strengths of acitrom were not color coded. A majority (85.5%) verbally instructed their patients about the drug. Less than one fifths (18.2%) of the clinicians provided booklets and pamphlets for reference. Only 56.4% of clinicians were aware of the correct target range for INR to be achieved in patients. Dietary and drug history was not documented by 85.6% and 50.9% of clinicians respectively. Surgeons were more likely to give educational booklets to their patients, document a dietary history and instruct patients regarding concomitant alcohol use in comparison with physicians. Twenty (41.7%) clinicians reported that they encounter thrombosis as a complication in patients on OAT while 58.3% of the clinicians in the present study noted bleeding more often. Conclusion: There are significant lacunae in knowledge base among clinicians regarding oral anticoagulant therapy. More emphasis on physician education is needed for safe and optimal OAT in patients.
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Variables associated with persistence of C-Peptide secretion among patients with Type 1 diabetes mellitus p. 173
Ibrahim Abbood Zaboon, Abbas Ali Mansour, Nazar S Haddad
Background: C-peptide is a reliable method for estimating the beta-cell residual function. The objective of this study to assess the variables associated with persistence of C-peptide secretion among patients with Type 1 diabetes mellitus (T1DM). Patients and Methods: This was a cross-sectional study conducted from October 2015 to September 2016. This study enrolled patients with T1DM with at least 1 year or more duration. Random C-peptide with concomitant plasma glucose at least 144 mg/dl (8 mmol/l) was measured and at this cutoff considered as a stimulated value. Variables that were assessed were age at the time of enrollment, age at the diagnosis of diabetes, gender, family history of diabetes, duration of diabetes, frequency of insulin per day, insulin dose (units/kg/day), type of insulin, devices delivery, body mass index (BMI) at enrollment, blood pressure, glucose (plasma), lipid profile, glycated hemoglobin (HbA1c), thyrotropin (TSH), and antibodies to glutamic acid decarboxylase (GAD65), thyroid peroxidase antibodies (anti-TPO), and tissue transglutaminase antibodies-IgA (anti-TTG-IgA). Results: A total 324 patients were included in the study. A higher level of C-peptide has been seen if the disease acquired at the age of 18 years and older with detectable C-peptide observed among 17.7% of those diagnosed at age <18 years versus 31.7% for those aged 18 years or above. The more the duration of diabetes, the more is the loss of C-peptide. On logistic regression analysis, only duration of diabetes <6 years, and insulin dose <1 U/kg/day were statistically significantly associated with the detectable level of C-peptide in this cohort of T1DM. Conclusion: Diagnosis of TIDM at a late age, positive family history of diabetes, those requiring <1 U of insulin per kg per day, and higher fasting glucose was associated with higher and more detectable C-peptide. On multivariable analysis, the only duration of diabetes <6 years and insulin dose <1 U of insulin per kg per day remains significantly associated with detectable C-peptide after at least 1 year from the diagnosis of T1DM. The gender, the BMI, blood pressure, the number of insulin injections per day, GAD65, anti-TTG-IgA, anti-TPO antibodies together with random glucose, lipid profile, HbA1c, or TSH levels failed to predict detectable C-peptide at 1 year from the diagnosis of T1DM.
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Sex education of married women based on theory of planned behavior p. 180
Zeinab Jalambadani, Gholamreza Garmarodi, Mahmood Tavousi
Background: More than half of the sexual problems which cause life destruction and marital relationships are due to insufficient knowledge or false beliefs about sexual relationships. Theory of planned behavior (TPB) is one of the important theories that explain the main process of adopting health behaviors. This study investigates sex education based on TPB in married women visitors to Mashhad health-care centers in Iran. Materials and Methods: In this quasi-experimental study, 80 women visiting health centers of Mashhad city were studied, selected from 5 health centers by random-cluster method. Methods and data collection tool were the questionnaire which completed through the interview. The validity and reliability of this questionnaire were determined through face and content validity and through Cronbach's alpha and test-retest, respectively. Statistical Analysis Used: Data were analyzed using statistical SPSS (22) software, Spearman's correlation coefficient tests, and linear regression analysis. Results: In linear regression analysis, it was determined that attitudes, subjective norms, and perceived behavioral control (PBC) predict 0.45 overall of total variance of sexual function intention, which among these variables, the effect of subjective norms was more than the other ones (P value < 0.05). After educational intervention, the average rates of knowledge, attitude, PBC, and intention to sexual function in sex education group were increased meaningfully (P value < 0.05); these changes were not meaningful in control group. There was also no statistically meaningful difference in subjective norms between two groups after intervention. Conclusion: According to findings, it is proposed that TPB be used to improve sex education.
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Impact of structured educational program on maternal knowledge, attitude, and practice toward diarrhea management in children <5 years age in Anantapur District p. 186
Guddeti Sunanda, Dasaratha Ramaiah, Mantargi Mohammad Jaffar Sadiq, Goruntla Narayana
Introduction: Maternal knowledge, attitude, and practices (KAP) toward management and prevention of diarrhea in children <5 years age is essential as it maintains good quality of life by reducing the morbidity and mortality. Aim: A study is designed to assess the KAP of mothers before and after the structured educational program on management of diarrhea in children less the 5 years of age. Settings and Design: Quasi-experimental design without control was preferred to test the effect of education on KAP toward diarrheal management among mothers at a rural secondary care referral hospital situated at resource challenged settings of south India. Subjects and Methods: A total of 384 mothers were enrolled and given education regarding the childhood management and prevention of diarrhea. A prevalidated KAP questionnaire toward management and prevention diarrhea was used to assess maternal KAP levels before and after the structured educational program. Statistical Analysis: Epi-Info-7 statistical software was used for data analysis. Descriptive statistics such as frequency and proportion were calculated for demographic characteristics. Chi-square test was used to test differences between the pre- and post-intervention KAP levels. Results and Discussion: The majority of women (56.7%) were belonging to the age group of 20–29 years. Among all the participants, nearly 85.4% were illiterate. Most of the women were of lower socioeconomic status (69.7%). There is a significant effect of structured educational program on maternal knowledge (χ2 = 577.2; P < 0.05), attitude (χ2 = 326.3; P < 0.05), and practice (χ2 = 347.3; P < 0.05) toward diarrhea management and prevention. Conclusion: Structured educational program targeting health-care providers and mothers primarily focusing on management and prevention of diarrhea shall improve the clinical outcomes in children <5 years of age.
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Comparative evaluation of four different sterilization methods on contaminated endodontic files p. 194
Malathi Yenni, Sujatha Bandi, Sai Sankar Jogendra Avula, Pratap Goud Jai Shankar Margana, Pranitha Kakarla, A Amrutavalli
Background: The reuse of instruments in the field of endodontics leads to cross infection due to contamination with microbes as the instruments come into direct contact with saliva, blood, and infected tissues. Since microbes are considered to be the major cause of endodontic failures, sterilization of endodontic instruments is mandatory for maintaining asepsis to prevent cross-contamination from one person to other. Hence, the present study was conducted to compare the effectiveness of four different methods of sterilizing contaminated endodontic files. Materials and Methods: A total of 48 stainless steel K files were divided into four groups based on the sterilization method followed – Group A: Autoclave, Group B: Glass bead sterilization, Group C: Glutaraldehyde, and Group D: Quitanet Plus (aldehyde-free solution). In all the tested groups, half of the files were contaminated with Escherichia coli and remaining with Enterococcus faecalis. Then, presterilization colony counts were recorded, followed by sterilization through respective methods. Later, the sterilized files were rinsed with distilled water and 100 ul of the diluted concentration was transferred and cultured onto the respective agar plates to determine the total microbial reduction. Results: Autoclave showed complete effectiveness in reducing the microbial count followed by Quitanet Plus, glass bead sterilizer, and glutaraldehyde. Conclusion: Autoclave is considered to be the best sterilization technique to prevent cross infection in endodontic therapy.
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Unusual antithyroid drug-induced hypoglycemia p. 198
Manish Gutch, Annesh Bhattacharya, Sukriti Kumar, Rajendra Kumar Pahan, Rao Somendra Singh
Insulin autoimmune syndrome is defined as the occurrence of spontaneous hypoglycemia attacks with high titers of anti-insulin autoantibodies in patients with no previous exposure to insulin. This rare syndrome has mostly been reported from the Japanese population and is frequently associated with other autoimmune conditions and certain drugs, especially those containing a sulfhydryl group. Most cases undergo spontaneous remission following removal of the offending drug. We hereby describe the case of a female who developed this rare syndrome following intake of carbimazole for Graves' disease.
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A rare case of collision tumor: Massive mucinous cystadenoma and benign mature cystic teratoma arising in the same ovary p. 201
Reddy Ravikanth
Collision tumor means the coexistence of two adjacent, but histologically distinct tumors without histologic admixture in the same tissue and is rare incidence involving the ovary. There are instances of collision tumors consisting of teratoma with serous cystadenocarcinoma, mucinous cystadenocarcinoma, and/or granulosa cell tumor. The possible existence of an ovarian collision tumor should carefully be examined pre- and post-operatively and histologically, so as to avoid misdiagnosis of a possible malignancy. We describe the findings in a histopathologically proven case of a massive mucinous cystadenoma and benign mature cystic teratoma arising in the same ovary.
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A modified physiologic impression technique for atrophic mandibular ridges p. 204
Smitha Daniel, Angleena Y Daniel, Nirmal Kurian
Restoration of comfort, esthetics and masticatory function in severely resorbed atrophic ridges is challenging to the clinician. Extreme resorption of the maxillary and mandibular denture bearing areas results in unstable and nonretentive dentures with associated pain and discomfort. These problems are more pronounced in mandible due to lesser denture bearing area and other anatomical limitations. This article attempts to present a modified physiologic impression technique using contemporary materials and suitable spacer design for atrophic mandible.
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Bell's palsy in an adolescent girl - not always a neurologist's territory: A case report and review of literature p. 209
Latha M Sneha, Raichel Priyanka, Shanthini Thanga Tamilselvan, Julius Xavier Scott
Infections, inflammatory, and autoimmune conditions are the well-recognized etiologies of acute facial nerve paralysis in children. Bell's palsy is idiopathic peripheral facial nerve palsy. Cranial neuropathies do occur in children due to the central nervous system involvement by malignancies but uncommon in pediatric acute lymphoblastic leukemias and even rarer in acute myeloid leukemias (AMLs). We report a case of a 13-year-old girl who presented with acute facial nerve palsy, was being treated as Bell's palsy elsewhere and was later diagnosed to have AML.
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A case of coombs-positive severe late anemia without hyperbilirubinemia, refractory to blood transfusion, improved with immunoglobulin p. 212
Supriya Kushwah, Ashutosh Kumar, Nithu George, H Mithun
Rhesus hemolytic disease of newborn is a well-known disease with early and late complications mainly manifesting as severe hyperbilirubinemia requiring prompt treatment such as exchange transfusion and immunoglobulins. We report a case of Coombs-positive severe late anemia without hyperbilirubinemia which presented with features such as sepsis and failure to gain weight. Baby was refractory to blood transfusion initially, but later on successfully improved with immunoglobulins.
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Xanthogranulomatous prostatitis with benign prostatic hyperplasia: A rare combination p. 214
Navjot Grewal, Amit Tuli, Francis K Sridhar, Kim John Mammen
Xanthogranulomatous prostatitis is a rare benign granulomatous inflammation of the prostate. Only ten cases of such pathology have been reported in literature. Patients usually present with symptoms of lower urinary tract symptoms. It occasionally resembles other prostatic diseases such as prostatic carcinoma and abscess. Imaging techniques are not useful in the diagnosis of xanthogranulomatous prostatitis; hence, it is diagnosed only on the basis of histopathological examination of prostate.
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Congenital double-double lip: A rare case report p. 216
Swati Phore, Rahul Singh Panchal
A double lip is a rare anomaly characterized by a horizontal fold of redundant mucosal tissue that is situated proximal to the vermilion border. It may be either congenital or acquired and has no gender or race predilection. It occurs most often in the upper lip, although both upper and lower lips are occasionally involved. Surgical intervention (simple excision) produces good functional and cosmetic results. In this report, a case of a nonsyndromic congenital maxillary double upper lip and lower lip, both are described. Double lip is of special interest in dental profession as a dental surgeon is normally the first one to diagnose this rare and uncommon condition. Authors hereby discuss a very rare condition in which both upper and lower lips are involved.
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Factitious cheilitis: A rare case report p. 219
Swati Phore, Rahul Singh Panchal
Self-injurious behavior (SIB) can be defined as the destruction or damage of body tissue without suicidal intent. Oral and perioral structures can be traumatized by SIB which involves biting of lips, cheek, lateral surface of the tongue, or buccal mucosa. Depending on its frequency and severity, SIB can lead to various degrees of self-injury. We hereby present a case of patient having lip lesion with positive history of lip chewing.
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Imaging and differential diagnosis of tectal plate gliomas p. 222
Reddy Ravikanth
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Smoking: A different perspective p. 224
Shveta Chauhan
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Management of von willebrand disease in pregnancy p. 225
Shiny Varghese, Divya Mahindru
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