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   Table of Contents - Current issue
April-June 2020
Volume 7 | Issue 2
Page Nos. 83-149

Online since Thursday, October 8, 2020

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Hepatorenal syndrome: A review into changing definition, diagnostic criteria, pathophysiology, and management p. 83
Vishal Bodh, Brij Sharma, Rajesh Sharma
Hepatorenal syndrome (HRS) is a form of kidney function impairment that characteristically occurs in patients with cirrhosis. The diagnostic criteria for this syndrome have been revised throughout the years, with recent revisions aimed at improving earlier diagnosis and treatment. HRS definition has been updated recently by the International Club of Ascites in accordance with Kidney Disease Improving Global Outcomes acute kidney injury (AKI) classification. Recent changes in terminology have led to acute or Type I HRS being referred to as AKI-HRS and chronic or Type II HRS as chronic kidney disease (CKD)-HRS. The contribution of systemic inflammation, a key feature of cirrhosis, in the development of HRS has been highlighted in recent years. The current standard of care for the management of HRS involves the use of vasoconstrictor therapy and volume expansion with albumin. All patients do not respond to treatment, and even in those who respond, early mortality rates are very high in the absence of liver transplantation (LT). LT is the only curative treatment of HRS.
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Stem cell research and therapy in India: General awareness for the public and stem cell therapy providers p. 90
Caroline Mathen, Neeta Devi Sinnappah-Kang
The rapidly evolving field of stem cell research and therapy, along with changing regulations requires clarity both for stakeholders and patients who take recourse as a last resort. If one was to do a search for a paper on public awareness in this area, there are very few, more so for India. The main objective of this article is to help the lay public and also those interested in providing stem cell therapy understand the current rules and requirements in India. This article provides important information in a concise, to the point and nontechnical way.
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Evaluation of role of cell block with immunohistochemistry in differentiating hepatocellular carcinoma from metastatic adenocarcinoma p. 95
Palash Kumar Mandal, Soumi Pradhan, Anindya Adhikari, Mimi Gangopadhyay, Dutta Pal Rupsha, Subrata Bhattacharya
Background: Fine-needle aspiration cytology (FNAC) is an increasingly common procedure in the diagnosis of neoplastic lesions of the liver, particularly in differentiating primary hepatocellular carcinoma (HCC) from metastatic adenocarcinoma (MA). However, there are certain limitations of FNAC. Sometimes, FNAC does not yield sufficient material for the precise diagnosis and the risk of the wrong diagnosis by FNAC cannot be excluded from the study. The aim of the study was to overcome such problems using a cell block (CB) technique along with immunohistochemistry (IHC) to diagnose and differentiate HCC from MA. Materials and Methods: This was a prospective study, conducted in a tertiary care hospital in Darjeeling district of West Bengal, over a period of 1 year. A total of 52 adult cases presenting with liver mass suspicious of malignancy were studied; CB with a histopathological examination and IHC for Hep par1 and CD10 were done in all cases. Results: In our study of 52 cases, CB with IHC was found superior in differentiating primary HCC from MA than only CB with a diagnostic accuracy of 96.15% and 92.31%, respectively. Among the IHC markers, Hep par1 was found more useful than CD10 with a diagnostic accuracy of 94.23% and 82.6%. However, CD10 was found to have greater diagnostic utility than Hep par1 in the context of poorly differentiated HCC. Conclusions: IHC study with Hep par1 and CD10 may be useful in differentiating HCC from the MA of the liver. Therefore, CB along with IHC improves the diagnostic accuracy of FNAC diagnosis.
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Work-related musculoskeletal disorders and ergonomic practices among dentists in Ludhiana p. 100
R Nissi Evelyn, Ritu Jain
Purpose: Prolonged static postures and forceful repetitive movements predispose the dentists for musculoskeletal disorders (MSDs). The purpose of the present study was to determine the prevalence of work-related MSDs (WMSDs) among the dentists in Ludhiana, Punjab, and to assess their knowledge, attitude, and practices regarding dental ergonomics. Methodology: A questionnaire-based survey was carried out among 146 dentists in the city of Ludhiana. Results:Majority of the surveyed dental practitioners (91%) were found to be suffering from WMSDs. The most common areas affected by WMSDs in the order of magnitude were the neck (70.5%), shoulder (48.7%), lower back (47.3%), and upper back (41.8%). It was found that senior consultants had better knowledge about dental ergonomics and had a better attitude toward applying ergonomic principles in their practice. Conclusion: The high prevalence of WMSDs exists among dentists. The knowledge about dental ergonomics does not necessarily lead to a positive attitude and practice of dental ergonomics. Incorporating the teaching, monitoring, and evaluation of ergonomic principles systematically into the undergraduate and postgraduate curriculum will improve the adoption and application of these principles in the routine clinical practices.
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Knowledge, attitude, and practice regarding voluntary whole-body donation among medicos in Northeast India p. 103
Nabarun Karmakar, Tamal Chakraborty, Anjan Datta, Kaushik Nag, Snigdha Das, Partha Bhattacharjee
Background: Voluntary whole-body donation is an important source of cadavers for anatomical study and research. As the medicos are intimately related to this, they should play vital role in the body and organ donation. Objective: The objective of the study was to assess knowledge, attitude, and practice (KAP) regarding voluntary whole-body donation among medicos in Northeast India. Methodology: This cross-sectional study was conducted among 361 medicos in Northeast India from March 2018 to June 2018. A pretested, semi-structured questionnaire was used to collect the required information on KAP regarding voluntary whole-body donation. The collected data were entered in SPSS version 16.0 and represented in proportions, and P < 0.05 was considered as statistically significant. Results: Most of the medicos (88.1%) knew about voluntary whole-body donation, and 60.7% of the respondents even replied that body should be brought to medical institute within specific time after death. Half of them (50.1%) got information from mass media, 10.8% from nongovernmental organizations, and 35.2% from doctors. Maximum (83.7%) agreed that body donation is useful for society, whereas 6.4% did not agree. Only 24.4% of the respondents had seen “donor card pledge form,” whereas only 7.5% (n = 27) were currently registered as a voluntary body donor. Conclusion: We found poor knowledge and attitude regarding various facets of voluntary whole-body donation; practice was even dismal among participants. Media and doctors being major source of information should spread the idea of voluntary whole-body donation that it is better to donate body after death, for research in medical education rather than cremation.
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A study to evaluate the effectiveness of competency-based training program for the dental interns of a tertiary care center in Jaipur city p. 110
Kopal Sharma, Amit Sharma, Kanu Neemawat
Background: The purpose of our study was to ascertain the effectiveness of competency-based training model for dental interns. Materials and Methods: This competency-based integrated training program was conducted for the dental interns of a dental college in Jaipur city. Clinical vignettes, interactive video lectures, webinar sessions, group discussions, and multiple-choice questions were the components of our training module. The whole program was divided into five modules, which were planned meticulously to achieve five different learning objectives. Before starting each module and at its completion, the students were evaluated for their performance by the same multiple-choice questions and the feedback of the students was taken. Results: The respondents included 8 (16.67%) males and 40 (83.33%) females, with a mean age of 22.34 ± 0.78 years. An increase in overall mean score was found in the posttest for all the five modules, and this was statistically significant with P < 0.001 using the Wilcoxon signed-rank test. Conclusion: Competency-based training program for the dental interns was very effective in training them various skills and knowledge that cannot be merely achieved by traditional teaching methodology. More integrated programs are warranted for dental undergraduates to train them to become a skilled practitioner.
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Prevalence of Tobacco Consumption among Men in Amarpur Village, Uttar Pradesh, India, May 2019: A cross-sectional study p. 115
Ali Jan Nazari, Naveen H Simon, Ajoke Akinola, Muskan Kaushik
Background: Globally, there are over 7 million deaths resulting from tobacco consumption with 1 million deaths in India per year, and among middle-income countries listed as the second major consumer of tobacco products. The prevalence of tobacco consumption according to the recent studies already done is dissimilar among gender, different age categories, religion, urban and rural areas. The study purpose was to assess the prevalence of tobacco consumption among rural men. Methodology: Community-based cross-sectional study conducted from December 2018 to May 2019 in Amarpur village, Uttar Pradesh, India. There were 244 men in the age group of 15–54 years old, selected for the survey. Purposive sampling technique was used for taking sample and SPSS 16 software for statistics analysis. Results: The prevalence of smoked and smokeless tobacco was 36.1% and 42.6%. The most prevalent form of tobacco among smoked form was bidi and hookah, while among smokeless forms were gutka with paan. Among the smokers, 69.3% were willing to quit smoking on smokeless consumers and 78.8% were willing to stop tobacco consumption at some point. Age, marital status, education, and the number of children were associated with tobacco smoker and chewer. Tobacco was highest 38 (48%) among 25–34 years of age for tobacco smoker with P = 0.002, and tobacco chewer highest among 35–44 years which was 34 (61.8%) with P = 0.000. About one-third of the patients do not know that tobacco intake has ill effect on their health; the most common influencing factors for tobacco use were for enjoyment and stress. Conclusion: Prevalence of tobacco consumption was high in this community. Urgent awareness and increased literacy needed to improve knowledge on the effect of smoking in the rural area. Through the development of effective health education and multi-factorial quitting strategies to help those who are willing to quit tobacco.
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Assessment of primary stability of immediate implants placed in the maxillary and mandibular anterior region using resonance frequency analysis p. 122
M Viswambaran, Kamal Verma
Background: A matter of controversy in implant dentistry concerns the most appropriate method to determine implant stability. Many methods have been reported in the literature including periotest and resonance frequency analysis (RFA). However, there is no consensus regarding the ideal method to determine implant stability. Materials and Methods: A total of 50 patients male and female in the age group of 18–38 years, each having at least one tooth indicated for extraction (either maxillary or mandibular anterior teeth) were selected. Fifty Xive implants (Friadent, Dentsply, Germany) were placed into fresh extraction sockets and immediately loaded. Implants were evaluated by clinical and radiographic methods. Implant stability was measured using periotest and RFA at the time of implant placement, 3 months, 6 months, 9 months, and 12 months postoperatively. Results: The mean mobility values for periotest decreased over a period of observation, and all implants consistently produced readings between −8 and + 7. The RFA values during the period of observation increased, and it was in the range of 49–100. Statistical analysis using regression analysis showed that percentage improvements in stability during each period were statistically highly significant in respect of periotest and RFA (P = 0.0001). Conclusions: A clinical trend of an implant stability quotient (ISQ) of more than 49 with a range of 49–98, is probably descriptive of osseointegrated implants. However, according to our experience, implants with a primary stability above 50 ISQ may be sufficient for successful immediate loading while implants below 40 could be dealt with caution and conventional loading can be considered in such cases.
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Clinical, electrophysiological, and histopathological profile of biopsy-proven vasculitic neuropathy p. 130
Suchitra Deolalikar, Preethi A M. Paul, Vineeth Jaison, Jayshree Nandi, Deepti Arora, Jeyaraj D Pandian, Mahesh P Kate
Background: Vasculitic neuropathies are an uncommon heterogeneous group of nerve disorders characterized by inflammation of the vasa nervorum, which may be either systemic vasculitic neuropathy (SVN) or non-SVN (NSVN). Settings and Design: This is a retrospective, observational study. Materials and Methods: Nerve biopsy-proven cases of vasculitic neuropathy (VN) from January 2011 to December 2017 were included in the study. Results: Twenty-five percent (40/156) patients had vasculitis on biopsy, 62.5% were male and the mean age was 52.8 ± 14.9 years. The median (interquartile range) duration of symptoms before diagnosis was 75 (345) days. Thirty (75%) patients had NSVN and 10 (25%) patients had SVN. The clinical pattern of peripheral nervous system involvement was as follows: 20 (50%) had polyneuropathy, 13 (32.5%) had mononeuritis multiplex, and 7 (32.5%) had polyradiculoneuropathy. Twenty-three (57.5%) patients received immunomodulatory therapy. Conclusion: VN has a wide spectrum of clinical presentation. High index of suspicion followed by nerve biopsy is needed for diagnosis. Early treatment may improve prognosis in this group of patients.
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Feasibility and diagnostic benefit of increased cerebrospinal fluid volume and frequency in the diagnosis of tuberculous meningitis p. 135
Sheena Evelyn Ebenezer, Ramya Iyyadurai, Joy Sarojini Michael, OC Abraham, Sowmya Satyendra Sudha Jasmine, KP P Abhihash, Jayaprakash Muliyil, Thambu David Sudarsanam
Background: Definite diagnosis of tuberculous meningitis (TBM) requires demonstration of TB bacilli in the cerebrospinal fluid (CSF) on smear, culture, or nucleic acid amplification. However, the sensitivity of these tests is low. This study was done to see if smear and culture done on a larger volume and repeated samples of CSF increases the diagnostic yield of these tests. Methods: Adult patients with clinical features of meningitis for >5 days were prospectively and consecutively recruited. At admission, the usual 1 ml of CSF was taken for mycobacterial testing; another 4–8 ml was also taken for the same as the comparison. On the 3rd hospital day, 4–8 ml of CSF was taken for mycobacterial testing. Mycobacterial smear and culture were done by Auramine O stains and on modified Lowenstein–Jensen medium, respectively. The composite reference standard for TBM was considered the gold standard for the diagnosis of TBM. Definite and probable diagnosis was taken as positive, while a possible diagnosis and no TB were considered negative for TBM. In a subset, Xpert MTB/Rif assay was also performed on the CSF samples as per the routine diagnostic protocol. Results: 66/80 (82.5%) had the initial CSF examination in the emergency department, 80 (100%) had large-volume CSF on day 1, while 22/80 (27.5%) consented for the second large-volume CSF examination on day 3. There was a marginal increase in sensitivity from 22% to 26% with increasing CSF volume from 1 ml to 4–8 ml and 36% if another large-volume CSF was collected at 72 h. The specificity was 100% at all times. The negative likelihood ratios were 0.78, 0.74, and 0.64, respectively. The sensitivity of Xpert MTB/RI compared to the composite reference standard of TBM was 30.4%. Conclusions: Increasing the volume and frequency of CSF testing for Mycobacterium tuberculosis, marginally improves the sensitivity and negative likelihood ratios, but may not be adequate to rule out TBM with the certainty required to withhold antitubercular therapy. The feasibility of repeat CSF examinations needs to be considered while making guidelines.
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Epidemiological study of body fat percentage, lean body mass, and total body water for Asian patients with chronic kidney disease Highly accessed article p. 139
Song-Hui Kim, Yu-Il Bang, Yong Ri, Gum-Hak Choe
Background: Malnutrition can have reversible effects on patients with chronic kidney disease (CKD). Patients with CKD are exposed to a wasting syndrome, because of disorders of nutrient absorption, excretion, and other factors. Aim: The aim is to identify changes in body fat percent (BFP), lean body mass (LBM), and total body water (TBW) percentage in patients with CKD using bioelectrical impedance analysis (BIA). Setting and Design: This study was conducted in 438 CKD patients (212 males and 226 females) attending a Nephrology Clinic in a Tertiary Level University hospital from 2008 to 2014, who were followed up for 6 months. Materials and Methods: The anthropometric and BIA data of all patients, who consented to participate, was collected and analyzed for LBM, BFP, and percentage of TBW. Results: Correlation coefficient of body mass index (BMI) and glomerular filtration rate is 0.20 and 0.227 in men and women in 0 week (baseline), respectively. In 24 weeks (endpoint), that is, 0.526 and 0688. In male patients, the average value of BFP was decreased 0.9%–1.4%, the average LBM was decreased 0.5–1.3 (kg/m, height), and then the average percentage of TBW was increased 0.3%–0.9% after G3 stage. In one side, in female patients, BFP was increased 0.3%–2.9%, the LBM was decreased 0.4–0.7 (kg/m, height), and then average percentage of TBW was increased 0.2%–0.8% after G3 stage. Collectively, BMI, LBM, and BFP were decreased according to CKD stage, in contrast with this, TBW percentage was increased. Discussion: These results suggest that protein-energy malnutrition is the main factor related to malnutrition in patients with CKD. The LBM and BFP were decreased, and percentage of TBW was increased in CKD.
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Acute pressor response in prone position during spinal surgery p. 146
Bhavna Hooda, Saurabh Sud, Deepak Dwivedi, Shalendra Singh
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Falciform ligament thrombosis: A rare cause of acute-onset pain in the right hypochondrium p. 148
Reddy Ravikanth, Kanagasabai Kamalasekar
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