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   Table of Contents - Current issue
January-April 2021
Volume 14 | Issue 1
Page Nos. 1-167

Online since Tuesday, February 9, 2021

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Zebrafish: An in vivo model for cancer research p. 1
Shridhar C Ghagane, Rajendra B Nerli
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Infection control measures during COVID-19 pandemic – An otorhinolaryngological and head-and-neck perspective p. 3
Santosh Kumar Swain, Sanjay Kumar
Otorhinolaryngologists and head-and-neck surgeons are considered as high-risk group of health-care workers due to their nature of work for exposure to the respiratory tract. During routine assessment and treatment of patients, otorhinolaryngologists and head-and-neck surgeons with their assisting staffs inevitably come in contact with secretions of the respiratory tract which may become aerosolized at time of the sneeze or cough. All otorhinolaryngology patients must be considered as potential carriers of COVID-19. A great emphasis must be given on the history such as flu-like symptoms, travel history, and contact history with potential carriers which will help triage patients into high risk. This review article discusses the infection control measures by otolaryngological and head-and-neck perspective during COVID-19 pandemic so will serve as template for otolaryngologists and head-and-neck specialist at the time of this outbreak.
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Burden, mortality, and associated factors of Pneumocystis jerovesi pneumonia among human immunodeficiency virus/AIDS patients: Systematic review and meta-analysis p. 12
Ephrem Awulachew, Kuma Diriba, Asrat Anja, Feven Wudneh, Aschalew Gemede
Pneumocystis pneumonia has classically been described as a serious complication in human immunodeficiency virus (HIV) infected patients caused by Pneumocystis Jirovecii pneumonia formerly called Pneumocystis Carinii Pneumonia (PJP). During the early period of the Acquire Immunodeficiency Syndrome (AIDS) epidemic, PJP was recognized as one of the AIDS-defining illnesses for as many as two-thirds of patients in the United States. Despite the introduction of combination antiretroviral therapy for the human immunodeficiency virus (HIV), PJP remains one of the leading causes of morbidity and mortality. The aim of the present study was to review existing literature on the burden, a mortality rate of PJP among HIV/AIDS patients and its associated factors. A total of 65 studies were eligible and included in this review. A meta-analysis by random effect model showed that the estimated pooled prevalence of PJP 15% (38,881/293,239; 95% confidence interval [CI]: 12%–21%). According to pooled estimates of this study, the overall mortality rate of PJP among HIV/AIDS patients was about 25% We demonstrated that CD4 level was significantly related to PJP infection, where the highest risk patients are those with CD4 count <200 cells/μl (odds ratio: 1.81, 95% CI: 1.22–2.69, P < 0.01). According to the pooled estimates of this study, PJP among HIV/AIDS patients was the cause of a high rate of morbidity and mortality.
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Prostate-Specific antigen: An overview and its current status in the diagnosis of prostate cancer p. 22
Siddalingeshwar Neeli, Manas Sharma, Abhijit Musale
Prostate-Specific Antigen (PSA), which has high organ specificity and poor cancer specificity, has been widely utilized for the diagnosis and treatment of prostate cancer; though it is not an ideal tumor marker. Its extensive usage in screening programs has resulted in a large number of unwanted biopsies, over-diagnosis and over-treatment of indolent cancers as well. Hence, various PSA derivatives and PSA-based tests have evolved to improve the accuracy of prostate cancer diagnosis. This article provides an overview of PSA and PSA-based biomarkers and their current role in the screening and diagnosis of prostate cancer.
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Burden, epidemiological pattern, and surveillance gap of rubella in Nigeria: A call for routine vaccination policy p. 31
Kabir Adekunle Durowade, Omotosho Ibrahim Musa, Maryam Abimbola Jimoh, Adekunle Ganiyu Salaudeen, Oladimeji Akeem Bolarinwa, Omowunmi Qubrat Bakare, Lukman Omotayo Omokanye
Rubella is an epidemic-prone disease with endemic transmission in Nigeria. It is a vaccine-preventable disease caused by the rubella virus whose devastating teratogenic effect makes it a disease of major public health importance when it occurs in pregnancy leading to congenital rubella syndrome (CRS) in infants. This article seeks to do a review of the burden, epidemiology, and examine the rubella surveillance gap in Nigeria. This is a review of literatures and the use of available World Health Organization secondary surveillance data to establish the burden, epidemiological pattern, and surveillance gap of rubella in Nigeria. Data were analyzed and presented with appropriate tables and charts. Epidemiologically, rubella occurs worldwide with seasonal variation. Available data from two geo-political zones (North-central and Southwest) of Nigeria showed that the peak incidence of rubella occur in the first 4 months of the year with most of the cases occurring in those <15 years and cuts across the rural and urban areas. Rubella and CRS are neglected diseases with no distinct surveillance system in place, no national incidence figure and no vaccination policy. The surveillance of rubella is integrated with that of measles with a noticeable poor case detection as only measles-negative blood samples are tested for rubella not minding the possibility of measles-rubella co-infection. With no national incidence figure and the gap in surveillance, rubella is under-reported in Nigeria. There is a need for a bridge of the surveillance gap and the government should have routine vaccination policy on rubella introduced in Nigeria.
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Understanding mental health perspectives of COVID-19 through the lens of Ayurveda p. 38
Janmejaya Samal
Coronavirus disease-2019 (COVID-19) is a global public health emergency and has affected more than 200 countries in the world. It was declared as a Public Health Emergency of International Concern by the end of January 2020 and a pandemic in March 2020. In addition to the public health challenges, this pandemic has created another parallel pandemic of mental health problems. Furthermore, the existing mental health problems have also been seen to exacerbate owing to this pandemic. The mental health problems are both seen among the community members and the health-care providers those who are in the continuous forefront of service provision in health-care settings. Ayurveda, the ancient medical doctrine of human civilization, delineates some of the tenets that can be understood and are pertinent to the current situation. Some of these tenets could be useful in mitigating the mental health issues that the current world is grappling with owing to COVID-19. Concepts such as Sadvrutta, Achara Rasayana, Adharma, and Prajnaaparadha hold contemporary relevance in the context of COVID-19.
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Analysis of gut bacterial community composition in obese and lean Indian participants by denaturing gradient gel electrophoresis p. 42
Tej Bahadur, Rama Chaudhry, Vishwa Deepak Bamola, Alka Mohan Chutani, Anil Kumar Verma, Jaishree Paul
Background: Human gut microbiota consists of variety of microbes which play vital role in the host development, physiology and homeostasis. Alteration in gut microbial composition or dysbiosis may lead to various diseases and lifestyle disorders including obesity. Since gut microbiota varies with differences in dietary habits and geographical locations therefore studies are required to look into the gut microbial diversity in Indian obese and lean subjects whose dietary habits and geography are different from the western world. Therefore, the present study was conducted to assess the microbial diversity in obese and lean Indian subjects. Materials and Methods: Subjects with similar dietary habits were enrolled in the study. Fecal samples were collected from each individuals and DNA was extracted. Polymerase chain reaction (PCR) was performed to amplify the 16S ribosomal RNA gene (V1-V5 region) followed by GC clamp PCR (V3 region) for the same. PCR products were run on Denaturing Gradient Gel Electrophoresis (DGGE) system and DGGE sketches were analyzed in Gel Compar II version 6.6 software (Applied maths, Belgium) to assess the gut microbial diversity. Results and Conclusion: The results showed variation in the gut microbial profiles among obese and lean individuals and revealed more microbial diversity in the lean as compared to obese individuals. These observations indicate that BMI is a contributing factor for the difference in gut bacterial profile of obese and lean subjects and that support the role of gut microbiota in obesity.
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Cross-sectional study of awareness toward COVID-19 among medical students of Kumaun region of Uttarakhand p. 48
Thakkar Hemaben, Sujan Singh, Poonam Kumari, Mohd. Maroof, Maneesh Bhatt
Background: COVID-19 pandemic has been declared as a public health emergency of international concern by the World Health Organization. Being highly contagious in nature, it has become a major concern for healthcare profession. Aims and Objectives: The aim of the study is to assess the medical students' awareness regarding risk perception, disease transmission, and prevention of COVID-19 and to study their source of information and activities affected by lockdown. Materials and Methods: We conducted an online, descriptive cross-sectional study in April–May 2020, using WhatsApp Messenger. Medical students of 1st-year and 3rd-year (posted in community medicine department) in Government Medical College, Haldwani, were approached through convenience sampling. Frequencies and proportions were computed for descriptive purposes. Chi-square test was utilized for statistical significance. Results: A total 244 1st-year and 3rd-year medical students, consisting of 106 (43.4%) males and 138 (56.6%) females, have participated in the study with a mean age of 20.8 (standard deviation 1.66) years. Overall, more students from either batch and gender found the disease very dangerous. TV was the most frequent source of information for their awareness. Almost similar frequency of students felt their social activities/visits affected during the lockdown period. Majority of students were aware about the important clinical features of COVID-19. Most of them agreed upon various modes of transmission severe acute respiratory syndrome coronavirus 2. The most frequently reported source of transmission was going to crowded spaces and exposure to coughing and sneezing. All students agreed for hand washing and avoiding contact with an infected person as the prevention method for COVID-19. Only about one-fourth of the students reported correct distance to be maintained between people. Conclusion: There is a need for regular educational interventions and training programs on infection control practices for COVID-19 to minimize the risk of transmission to healthcare students.
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Awareness about donning and doffing of personal protective equipment among doctors working in a fever clinic of West Bengal Highly accessed article p. 53
Ankita Mishra, Vineeta Shukla, Ripan Saha, Kuntala Ray, Raghunath Misra, Mausumi Basu
Background: Fever clinics were established across the country for screening of patients suggestive of coronavirus disease-2019 (COVID-19). The doctors posted in these clinics were provided with personal protective equipment (PPE) for their protection. Improper use of these equipment may result in infection. Objectives: The objective is to assess the awareness of doctors posted at fever clinic regarding donning and doffing of PPE. Materials and Methods: A cross-sectional descriptive study was carried out from May to June 2020 on doctors posted at the fever clinic of Sambhunath Pandit Hospital, Kolkata by census method using a predesigned, pretested structured questionnaire (Google form). Statistical analysis was done with the help of appropriate statistical software. Results: None of the doctors working in the fever clinic had adequate knowledge regarding steps of donning and doffing of PPE while 77.4% doctors did not know the correct steps of maintaining hand hygiene. Still the percentage of participants with satisfactory knowledge and satisfactory attitude regarding PPE was 84.9% and 62.3%, respectively. Conclusions: This study suggests that there is a need for active training of the study population in order to effectively protect them from COVID-19.
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A study of association between breastfeeding and iron-deficiency anemia status in infants and young children between 0 and 2 years p. 60
Amit Magadum, Sowjanya GT, MB Koujalagi, CR Banapurmath
Background: Iron deficiency is one of the biggest contributing factors to the global burden of anaemia. It is an indicator of both poor nutrition and poor health. Results of recent basic research support the concerns that IDA during infancy and childhood can have long lasting detrimental effects on neurodevelopment. Objective: To study contributing factors for IDA in infants and young children between 6-24 months. Study Design: A case control study. Participants: Children aged between 6-24 months, admitted or attended OPD in paediatric wards of 3 hospitals attached to JJM medical college. Intervention: No intervention was involved in this study. Outcomes: This study findings revealed the status of iron deficiency anaemia among 6-24 months children and also its contributing factor which influence the indication. Results: In our study 50% were anaemic, 50% were not anaemic, in that, 27.1% had moderate anaemia, 22.9% had severe anaemia. Compared to early initiation of breastfeeding at birth, delayed initiation of breastfeeding was associated with higher chances of IDA. Those children who were not exclusively breastfed for first 6 months had higher chances of IDA. Initiation of top milk before 12 months was associated with higher chances of IDA especially before 6 months. Conclusion: Top feeding, faulty weaning and feeding practices are the main contributing factors of anaemia among children under 2 years.
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Correlation between physical abuse and anxiety among school-going adolescents (10-16 years age) of Belagavi: A school-based study p. 66
Gavishiddhayya B Salimath, Sudha A Raddi
Introduction: The relationship between childhood maltreatment and bountiful range of mental divergence has been well assumed. Anxiety disorders are the usual mental health concern facing adolescents today, yet they are largely insufficiently treated. Physical abuse often does not occur in isolation, but as part of a constellation of behaviors including authoritarian control, anxiety-provoking behavior, and a lack of parental warmth. Objectives: To find out the correlation between physical abuse and anxiety among school-going adolescents. Materials and Methods: The present study was conducted among eight schools at Belagavi, using descriptive cross-sectional research design with stratified cluster sampling. It included primary and secondary schools of Belagavi. The study samples were consisted of 785 students. Self-structured physical abuse and anxiety scales were used to find out correlation between physical abuse and anxiety among the adolescents. Results: The results of the study showed that out of total 785 study participants, 444 (56.56%) had exposed to moderate physical abuse, 196 (24.97%) had exposed to low physical abuse, and 145 (18.47%) had exposed to high level of physical abuse. The study findings showed that there is a significant positive relationship between physical abuse and anxiety among adolescents, with r = 0.1021. Conclusions: The present study concluded that there is a significant positive relationship between physical abuse and anxiety among adolescents.
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Peripheral nerve block (FLOS block) for intraoperative anesthesia in total knee arthroplasty: An observational study p. 72
Sangeeta Khanna, Biraj Gogoi, Sharma Vipin Jaishree, G V Krishna Prasad
Background: Peripheral nerve blocks (PNBs) are generally used to provide postoperative analgesia after total knee arthroplasty (TKA) and other lower extremity procedures; these blocks are used rarely for intraoperative anesthesia. We present here, the patients who underwent TKA under PNBs (FLOS Block). FLOS block is nothing but femoral, lateral cutaneous femoral nerve, obturator, and sciatic nerve block. Materials and Methods: A total of 41 patients participated in the study for TKA using PNB, FLOS block. All the patients received standardized anesthesia and analgesia upon hospitalization. Outcome evaluations included the visual analog scale (VAS) scores during surgery, activity at rest, postoperative blood pressure, and heart rate, also the sedation for femoral, lateral cutaneous femoral nerve obturator and sciatic nerve (FLOS) blocks. Compared with neuraxial (spinal/epidural) anesthesia, PNB (FLOS Block) minimizes hypotension, minimizes urinary retention, improves patient satisfaction, ambulation restrictions, and eliminates the risk of spinal hematoma and infection. Results: The finding suggests a decreased requirement of opioids in the PNB technique (FLOS Block). Pain scores, assessed by subjective VAS scale, were accurately handled in all the patients reviewed, with good pain control with PNB (FLOS Block). PNB (FLOS Block) provided stable hemodynamic, prolonged, and better postoperative analgesia. Intraoperative anesthesia was very satisfactory for surgery. The requirement of total doses of rescue analgesics, VAS score peroperatively for 48 h, the incidence of side effects, and complications were very few and acceptable. Conclusion: A femoral, sciatic nerve block with obturator and lateral femoral cutaneous nerve block may be an option to the spinal epidural anesthesia in the patients undergoing TKA. PNB (FLOS Block) showed similar patient satisfaction and postoperative analgesia to spinal-epidural anesthesia.
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Burnout among nurses at a tertiary care hospital of South India p. 80
Anchu V Raju, Aneeta Emmanual, Dilty Shaji, Mohammed Rithu Faizal, Priya Reshma Aranha
Background: Burnout is clearly identified as a problem in the area of human services that need to be addressed. Burnout negatively affects the health and personal lives if the employees experiencing it. Nurses are more prone for burn out in their day-to-day professional life. Objectives: The present study was conducted to determine the burnout among the staff nurses and to find association of burn out scores with selected demographic variables. Materials and Methods: A quantitative research approach with descriptive survey design was adopted for the study. The study was conducted in selected tertiary care hospital. The variables under study were burnout and demographic variables. Using nonprobability purposive sampling technique, 100 staff nurses were selected as study samples. Demographic pro forma and self-reported burnout inventory scale were used to collect data. The data were analyzed using descriptive and inferential statistics. Results: The study result showed that majority (83%) of the nurses had high level of burnout, 3% had very high level of burnout and 14% had moderate level of burnout. Conclusion: The study concluded that majority of the study participants had high level of burnout. Necessary action to be taken to reduce burnout among staff nurses to improve the quality care provided by them and also to have a conducive working environment for the staff nurses.
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Case-based learning in neurophysiology: An educational paradigm for preparing undergraduate medical students for better clinical acumen p. 84
Reshu Gupta, Raman Grover
Background: Case-based learning (CBL) is an effective educational strategy of solidifying basic physiological concepts and integrating them to clinical application and clinical sciences. The study aimed to measure its effectiveness in achieving the defined learning outcomes and assess and evaluate the academic performance and perception of 1st year medical students in neurophysiology toward developing a better clinical acumen. Materials and Methods: A quasi-experimental study of 100 1st year medical students was conducted. 89 students in the first and 86 in the second CBL session were final participants after dropouts. After a conventional lecture on neurophysiology, they were assessed by a pretest in the form of multiple choice questions. Then, they were divided into 9 groups to solve a clinical case problem via group discussion followed by group presentation, a posttest, and an open discussion by the facilitator. Five-point Likert scale feedback was taken; the scores were statistically assessed by paired Student's t-test and the feedback was assessed by median, interquartile range (IQR), and Chi-square goodness-of-fit test. Results: Higher mean posttest scores (2.84 ± 0.94 for the first and 3.77 ± 0.93 for the second session) suggested a statistically significant improvement in the students' academic performance (P < 0.001 and P < 0.002, respectively). Majority of the feedback responses favored a positive impact of CBL (P = 0.05; IQR averaging around 1 and 2 in majority). Conclusion: CBL encourages active learning in physiology, and not only helps students to gain requisite knowledge but also enhances their communication and analytical skills.
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Validity of the IND IsoDyno isokinetic dynamometer maximum peak angular torque measure for right knee joint flexion and extension movement p. 90
Shubhankar S Mahapure, Neeraj A Athavale, Ashok K Shyam, Parag K Sancheti, Akshay S Nirgude, Niranjan R Bhore
Context: IND IsoDyno isokinetic dynamometer is a newly designed dynamometer to measure the isokinetic strength of the knee joint. It is a cost-effective, clinically feasible, and easily available dynamometer which manifests its benefits over the preexisting one. Aim: The aim of this study was to assess the validity of IND IsoDyno isokinetic dynamometer with respect to maximum peak angular torque. Settings and Design: Criterion-related validity (concurrent validity). Materials and Methods: We considered IND IsoDyno isokinetic dynamometer as an index test and TecnoBody IsoMove isokinetic dynamometer as our reference standard. In this study, we assessed the validity of the IND IsoDyno isokinetic dynamometer and compared the obtained maximum peak angular torque values of the prototype device. Five volunteers were tested at 60° per second on concentric mode for knee flexion and extension on both the IsoMove and a new isokinetic dynamometer IND IsoDyno. Data for values of maximum peak angular torque were recorded. Statistical Analysis Used: Interclass correlation coefficient (ICC) and standard errors of measurement (SEM) were analyzed using IBM SPSS version 26. Bland and Altman's method of analysis was done. Results: ICC and SEM revealed a high level of reproducibility and precision in the device's maximum peak torque measurements. The 95% confidence interval (CI) interval falls between the limits of agreement on Bland and Altman's plot. Conclusions: Within the limitations of the study, IND IsoDyno isokinetic dynamometer provided a mechanically valid measure of maximum peak angular torque on multiple trials performed on various subjects.
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An intervention-based study to assess the acceptability and effectiveness of a breast health awareness program among rural women of Southern Haryana, India p. 96
Avinash Surana, Rakesh Tank, DR Rajesh, Abhishek Singh, Vikas Gupta, Deepika Agrawal, Virender Kumar Chhoker
Introduction: Breast cancer is among the most prevalent cancers in India and improving breast cancer awareness among women has shown to overcome the barriers related to diagnosis and treatment. Although breast self-examination (BSE) being quite easy and fast procedure, it a matter of debate that in limited-resource settings, it could be implemented or not, and hence, the present study was conducted to assess the acceptability and effectiveness of a breast health awareness program among rural women. Methods: The present prospective interventional study was conducted for a duration of 12 months among 270 rural women in the age group of 30–59 years. A pretested questionnaire was used to collect data. The activity of the study was divided into three parts, i.e., pretest, intervention and posttest. McNemar's Chi-square was used to examine the association between each dependent variable at pretest and posttest and an association was statistically significant if the P < 0.05. Results: Only 17.2% were aware of BSE and among them, not even single has ever practiced BSE. The pretest and posttest median awareness scores were 3 and 5, respectively, whereas the mean awareness score pretest and posttest were 2.76 ± 1.525 and 5.07 ± 1.598, respectively. Awareness regarding risk factors for breast cancer before training (11.1%) was increased significantly after training (35.2%) but to a little extent only (P < 0.001). Conclusion: The present study highlights the levels of baseline awareness of breast cancer in rural women, which is unacceptably low, but educational intervention by field health workers having significantly improved their level of awareness, including the BSE practices. The study also found various barriers for not performing BSE among participants.
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Effect of yoga on pulmonary function test, thyroid-stimulating hormone estimation, hand grip strength, and quality of life in participants with thyroid dysfunction: A pre-post clinical trial p. 103
Surya Krishnanunni, BR Ganesh
Background: Thyroid dysfunction is the most common occurring endocrine disorder among the general population. According to projections from several readings on thyroid disease, 42 million people in India have been estimated to be suffering from diseases as a result of thyroidism. Yoga has been found valuable in numerous diseases. Yogic exercise restores body roles through the manipulation of cardiovascular, respiratory, and metabolic control mechanism. Yoga has been proven to be an effective adjunct in thyroid conditions in various studies. Objectives: The objective of this study is to assess the effect of yoga on respiratory function, thyroid-stimulating hormone estimation, and hand grip strength as well as quality of life (QoL) in participants with clinically diagnosed thyroid dysfunction. Methods: Twenty-five participants aged between 20 and 50 years were enrolled for the trial. Yoga sessions of four times a week for 3 weeks were given to every subject. Pulmonary function test (PFT), thyroid function, grip strength as well as QoL was measured pre as well as post intervention. Results: Highly significant variations (P < 0.001) were noted within PFT, thyroid function, grip strength as well as QoL parameters Conclusion: Significant effect was found within all the parameters of PFT, thyroid function, hand grip strength as well as QoL following 3 weeks of yoga training.
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Effect of Panchatikta Ksheera basti with Kati basti in Katishoola w. s. r lumbar disc degeneration – A clinical study Highly accessed article p. 108
Neelam Kaalia, Santosh Kumar Bhatted, SH Acharya
Context: Low back pain is the most common clinical presentation in musculoskeletal disorder due to spinal pathology. Factors such as improper sitting postures, jerky movements in travel, sports activities, aging, and bad sleeping posture are the important factors to produce spinal disorders. Lower back pain has been associated with degeneration of the intervertebral disc. Aims: This clinical study was carried out to judge the effectiveness of Panchatikta Ksheera Basti (medicated herbal therapeutic enema) with Kati Basti in lumbar disc degeneration-induced Katishoola. Settings and Design: This was an open-labeled, single-arm, interventional clinical study. Subjects and Methods: Fifteen diagnosed cases of low backache with lumbar disc degeneration were registered from the outpatient and inpatient departments of All India Institute of Ayurveda, New Delhi, India, and Panchatikta Ksheera Basti as yoga basti followed by Kati Basti for 8 days was administered. Statistical Analysis Used: The data were statistically analyzed using paired t-test. Results: Significant (P < 0.05) result was found in all the assessment parameters, namely, pain, stiffness, and fasciculation. Conclusions: Panchatikta Ksheera Basti with Kati Basti is an effective treatment method for safe and effective management of Katishoola w. s. r lumbar disc degenerative disease.
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Clinicopathologic spectrum of glomerular diseases in a tertiary care hospital p. 113
Shalini Bhalla, Muffazal Ahmad, Shivanjali Raghuvanshi, Preeti Agarwal
Introduction: Biopsy-proven renal diseases give an insight into the prevalence of glomerular diseases. These are uncommon diseases which differ according to geographical area, demography, age, and race of a population. Aims: This study was aimed to evaluate the histopathological spectrum of glomerular diseases in native kidney biopsies. The secondary aim of the study was to review the literature for pattern of occurrence of glomerular diseases in and around the Indian subcontinent. Settings and Design: The present study was a retrospective observational study conducted at a tertiary care hospital for a period of 2 years. Subjects and Methods: One hundred and six consecutive native kidney biopsies performed under ultrasonographic guidance were done, and two renal core tissues, which were obtained in each case, were evaluated for light microscopy and immunofluorescence. Results: The age at presentation varied from 6 to 70 years, and maximum cases belonged to the third and fourth decades. The male-to-female ratio was 1.6:1. The most common clinical indication for performing the renal biopsy was nephrotic syndrome in 68 cases (64%). The primary glomerular diseases accounted for 86 cases (81.1%), and the remaining were secondary. Minimal change disease (MCD) was the most common histological lesion (29.2%), followed by focal segmental glomerulosclerosis. Among the secondary glomerular diseases, lupus nephritis was the most common, followed by amyloidosis. Conclusion: In this study of biopsy-proven renal disease, primary glomerulonephritis was found to be more common than secondary causes. Of the primary glomerulonephritis, MCD was the most common renal disease in patients of nephrotic syndrome. The study also highlights the similarities and differences in the spectrum of renal diseases in different regions of the Indian subcontinent.
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Acute epiglottitis in elderly age group: Our experiences at a tertiary care teaching hospital in Eastern India p. 119
Santosh Kumar Swain, Nibi Shajahan, Priyanka Debta, Somadatta Das, Rabindranath Padhy
Background: Acute epiglottitis (AE) is a potentially life-threatening condition which can lead to airway obstruction. It is less commonly encountered in elderly persons but has more potential for poor outcome due to the indolent property of the clinical presentations. Objective: The objective of this study is to assess the clinical presentations and management of the elderly patients who visited the outpatient department of otorhinolaryngology with AE. Materials and Methods: This is a retrospective study done at a tertiary care teaching hospital from December 2014 to November 2019. We searched our electronic medical records for patient details with the diagnosis of AE. The patients of more than the age 50 years were included in this study. Results: A total of 21 patients were included in this study. The age ranges were from 52 to 78 years, with the mean age of the patients was 59.21 years. The most common symptom was sore throat (n = 19, 90.47%), followed by odynophagia (n = 13, 61.90%), fever (n = 9, 42.85%), change in voice (n = 7, 33.33%), drooling of saliva (n = 4%, 19.04%), and dyspnea (n = 4, 19.04%). Seventeen patients were treated conservatively with the help of broad-spectrum antibiotics and steroids without the requirement of definite airway intervention. Two patients were intubated, one underwent tracheostomy and one underwent cricothyrotomy. Conclusion: In elderly patients with AE, sore throat is the most common clinical symptom, but stridor is less common. Conservative management is commonly utilized for the management of AE in elderly patients. If AE left untreated, can progress to life-threatening airway obstruction and so the diagnosis not be missed.
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Digital devices; a boon or bane: Ocular and musculoskeletal manifestations during lockdown in COVID-19 pandemic among general population of North India p. 124
Sneha Kumari, Pankaj Ranjan, Mitasha Singh
Introduction: During the lockdown in COVID-19 days, excessive usage of digital devices leads to various consequences of ocular and musculoskeletal problems, mainly in the form of computer vision syndrome (CVS) and repetitive strain injury (RSI). Objectives: The objective of this study is to estimate the prevalence of symptoms of CVS and RSI and their association between the duration of use of electronic devices among the general population of North India during the period of lockdown (March–May, 2020). Methodology: The present study was a cross-sectional, descriptive, population-based study conducted during the 2 months period of lockdown between April and May 2020. The general population of all age groups of North India who were using any form of digital device with internet connectivity was included in the study. Sample size of 255 was achieved. Convenience and snowball sampling technique was applied. Study tool was pretested, structured, self-administered online survey forms using the Google forms. Results: One or more symptoms of CVS were reported by 69% of the study population while 21.6% reported repetitive strain injuries. Around ten times significantly higher probability of having CVS was observed among those with more than 9 h of usage of electronic devices per day (odds ratio [95% confidence interval]; 9.94 [3.07–32.16]) as compared to those using it for < 2 h a day. Conclusions: It is the need of the hour that there should be extensive dissemination of information, education, and communication services regarding the symptoms of CVS and RSI and their preventive measures among the general population.
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Performing tracheostomy on COVID-19 pediatric patients at intensive care unit: Our experiences p. 131
Santosh Kumar Swain, Ansuman Sahu
Background: The novel coronavirus disease-2019 (COVID-19) is posing unprecedented challenges among health-care workers for managing the pediatric tracheostomy. Tracheostomy and posttracheostomy care are considered as high-risk procedures for contamination of health-care workers and other patients of the intensive care unit (ICU) in COVID-19 pandemic. Objective: The objective of this retrospective study is to evaluate the details of pediatric tracheostomy including patients' profile, surgical steps, complications, and precautions by health-care workers at the ICU of the specially assigned hospital for COVID-19 patients. Materials and Methods: This is a descriptive retrospective study in which 18 COVID-19 pediatric patients underwent bedside surgical tracheostomy at the ICU. Clinical patient's profiles such as age, sex, comorbidities, complication of the tracheostomy, ventilator withdrawal after tracheostomy, and nosocomial infections of the health-care professionals related to tracheostomy were analyzed. Results: Of the 18 patients with COVID-19 infections who underwent tracheostomy, there were 11 male (61.11%) and 7 female (38.88%) with a male-to-female ratio being 17:1. The age ranged from 4 years to 18 years, with a mean age of 11.45 years. The mean duration from the day of the orotracheal intubation to the day of tracheostomy was 12 days. Conclusion: Performing surgical tracheostomy on COVID-19 pediatric patients is a high-risk aerosol-generating procedure for health-care professionals. It should be performed with close association with pediatric otolaryngologists, anesthesiologists, and pediatric intensive care physicians along with adequate personal protective equipment for smooth and safe execution of the procedure.
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Serum levels of allopregnanolone in migraine patients: A case–control study p. 137
Makpere Delikanli, Nesrin Gökben Beceren, Cihan Bedel, Mustafa Korkut, Hamit Hakan Armağan
Introduction: Migraine is a very common disorder and the mechanisms contributing to headache still remain controversial. Allopregnanolone (AP) is a neurosteroid metabolite of progesterone. Previously, there were some studies of AP on the positive effects of many diseases. Objectives: The aim of this study was to evaluate AP levels in patients with migraine and compare with levels measured in healthy individuals. Materials and Methods: This case–control study included fifty patients with acute migraine headache who were previously diagnosed with migraine and fifty sex- and age-matched healthy volunteers with no headache complaints. Migraine patients who fulfilled the International Headache Classification criteria of migraine and healthy controls were included in this study. Plasma AP levels were compared in both groups. Results: Fifty patients (35 females and 15 males) and fifty healthy volunteers (38 females and 12 males) fulfilled the inclusion criteria and were enrolled in the study. AP levels of migraine patients and control group were compared; there was a statistically significant difference between the two groups (1.22 ± 1.92, 6.07 ± 4.89, respectively; P < 0.001). AP levels were significantly higher in healthy people. Conclusion: This study showed that low AP levels were detected in migraine patients. These markers may contribute to our understanding of the pathophysiology of migraine.
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Defining the normal range for screening panel of neutrophil function tests in healthy adult Indian participants p. 141
Shivanand S Pattan, Kishore G Bhat, Vijay M Kumbar, Manohar S Kugaji, Geeta Pattar
Background: Neutrophils, the most abundant white blood cells are known to play a major role in the fundamental physiological response to tackle with microbial infections via different mechanisms. A series of assays have been developed that mimic neutrophil functions both in vivo and in vitro to look at specific deficiencies of neutrophil function. There is need to develop method to have defined normal range for these tests to differentiate between health and disease. We aim to define normal range for panel of screening assays in healthy adult Indian participants. Materials and Methods: The study included 30 male and 30 female adult healthy participants. A volume of 10 ml of blood was collected from each participant. Four different assays that included chemotaxis, phagocytosis, intracellular killing (candidacidal assay), and nitroblue tetrazolium (NBT) test were performed. For defined range was established for all the assays. Simultaneously controls were set up for all the tests. Results: For NBT assay, the mean values for control and test were 13.58 and 58.90 respectively. The mean values for the control and test for phagocytosis assay were 1.77 and 4.49. Similarly, the values for candidacidal assay were 11.67% and 34.98. Finally, the values for chemotaxis test were 2.13 cm for Formyl-Methionyl-Leucyl-Phenylalanine, 0.54 cm for participant's serum and 0.48 cm for the medium. Conclusion: Based on the data generated, the values produced in the present investigation should be considered as normal range for adult population between the age group of 25–50 years for the protocols followed in the study.
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Laparoscopic primary ureterocalicostomy in children with ureteropelvic junction obstruction p. 146
RB Nerli, Pathade Amey, Shridhar C Ghagane, Sushant Deole, Murigendra B Hiremath
Introduction: Ureterocalicostomy (UC) involves excision of the hydronephrotic lower renal pole parenchyma and anastomosis of the dismembered ureter directly to the lower pole calyx. UC offers distinct advantages, notably for obstruction secondary to complicating anatomical anomalies of the kidney, such as horseshoe kidney. The present study was aimed to assess our experience and evaluate the outcome of primary laparoscopic UC in children with ureteropelvic junction obstruction (UPJO). Materials and Methods: We retrospectively reviewed the clinical notes, imaging records, and laboratory investigations of all the children who had undergone laparoscopic UC as a primary procedure in our center during a 12-year period (January 2006–December 2017). Results: Ten children (six males and four females) underwent laparoscopic primary UC for UPJO during the study period. The mean age of the children was 10.8 ± 2.78 years. The mean operating time was 175 min (range 140–210 min). No major intraoperative complications were noted. Conclusions: Primary laparoscopic UC for UPJO with complicated renal anatomy is feasible, safe, and associated with minimal morbidity. The outcomes show adequate drainage of the pelvicalyceal system.
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Determination of phenotypic alteration of arecoline-induced buccal mucosal fibroblasts: An in-vitro cell culture study p. 150
Ritiha Patil, Alka D Kale, Deepa R Mane, Dhanashree Patil
Introduction: Oral cancer is one of the worldwide health problems accounting as the 6th common of all malignancies. Majority of the oral cancer develop from premalignant conditions of the oral cavity due to the chronic habit of tobacco chewing and smoking. The prominent cells of the oral mucosa are fibroblasts playing a major role in synthesis of extracellular matrix, wound healing, and wound repair. Arecoline, one of main ingredients of tobacco is considered as a risk factor for the development of oral premalignant lesions and cancer. The arecoline is reported to have both genotoxic and morphological alteration of oral fibroblasts leading to Oral submucous fibrosis. Thus in our study a dose dependent effect of arecoline was assessed on the morphology of cultured Human Buccal Mucosal Fibroblasts. Aim: The aim of our experiment is to assess the effect of different concentration of arecoline on the morphological variation of primary cell lines of human buccal mucosal fibroblasts to develop a model of altered fibroblasts. Materials and Methods: The primary cell lines of human buccal mucosa were established in BSRC KAHER Belagavi, and authenticated by STR profiling from DNA forensics Lab New Delhi. The cells were further cultured and assessed after treating with different concentration of arecoline hydrobromide. The treated cells were then observed for the phenotypic changes and recorded. The morphological alterations were compared to the untreated fibroblasts. Results and Conclusion: In our study, a dose-dependent effect of arecoline was assessed on phenotypic or morphological alteration of buccal mucosal fibroblasts. The results justified that concentration of arecoline lower than 125 μg/ml did not show change in the morphology of buccal mucosal fibroblasts, whereas the concentration of arecoline >250 μg/ml showed altered fibroblasts. Hence, it can be concluded that the levels of arecoline in arecanut chewers if it is >250 μg/ml, the mucosal fibroblasts may undergo changes to cause fibrosis of collagen. The future scope of our study is to determine the genotoxic effects of arecoline on buccal mucosal fibroblasts and also to develop the therapeutic effects.
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An unusual presentation of rhinosporidiosis p. 156
Santosh Kumar Swain, Ansuman Sahu
Rhinosporidiosis is a chronic granulomatous infection of the nose and nasopharynx. It is endemic in South Asia and commonly affects males in their second to fourth decades of life. Majority of the cases are found in the upper respiratory tract such as anterior nares, nasal cavity, inferior turbinate, nasal septum, floor, and nasopharynx. Although nose or nasopharynx is the most common location for rhinosporidiosis, it can also involve the skin, parotid duct, oropharynx, and larynx. Here, we report the case of a 42-year-old male who presented with extensive rhinosporidiosis in both nasal cavities and nasopharynx along with involvement of the roof of the oral cavity through erosion of the hard palate. The mainstay of treatment is wide excision followed by electrocautery of the base which ablates the recurrence. The rhinosporidiosis mass from different sites of the attachment was completely excised along with cauterization of the base. The diagnosis was confirmed by histopathological report.
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Histiocytic necrotizing lymphadenitis with systemic lupus erythematosus mimicking like lymphoma p. 160
Majed Abdul Basit Momin, Amit K Sarda, Sunitha Kayidhi, Abhijeet Ingle, Dharmendra Kumar Borad
Histiocytic necrotizing lymphadenitis (HNL) is a rare idiopathic disorder. It is frequently underdiagnosed due to its nonspecific clinical features, mimicking like lymphomas, autoimmune diseases, and infectious reactive lymphadenopathy. Histological examination of the lymph node is the basis of diagnosis in HNL. We report a 40-year-old male patient who presented with fever for 4 weeks. After an extensive workup, laboratory investigations revealed progressive pancytopenia, gradual increase in serum lactate dehydrogenase, and ferritin with negative pyrexia profile. His radiological imaging including positron emission tomography/computed tomography showed multiple intra-abdominal, cervical, and axillary lymphadenopathies. Finally, the histological section from axillary lymph node core biopsy revealed a diagnosis of HNL. Subsequent autoimmune workup met diagnostic criteria for systemic lupus erythematosus. This case report alerts the clinicians regarding this rare disease and emphasizes the important role of morpho-histopathology in early recognition of this rare entity.
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Need for a holistic approach to contain hepatitis C: World Health Organization p. 164
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
Hepatitis C has been acknowledged as one of the global public health concerns owing to its universal distribution, high incidence, impaired quality of life, and associated life threatening complications, including death. The need to have an urgent public health response is further emphasized by the fact they tend to cast a major financial burden on the community. Considering the huge burden of the chronic infections, it is high time that the access to affordable testing and treatment is given due importance. However, as with any other program, the success of the program requires sustained financial support and simultaneous investments have to be done for innovations, including the development of vaccines. Further, efforts have to be taken to increase the awareness about the disease and mobilization of resources. In conclusion, in order to prevent and control the disease and to meet the proposed targets, the need of the hour is to foster linkage with all the stakeholders and scale up the screening, diagnosis, care and treatment services.
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Incidental finding of non-Peutz-Jeghers syndrome-associated ovarian sex cord tumor with annular tubules p. 166
Kavita Mardi
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