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   Table of Contents - Current issue
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July-December 2020
Volume 11 | Issue 2
Page Nos. 83-209

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EDITORIAL  

Microbes from mouth to gut impacting probiotics to antibiotics Highly accessed article p. 83
Vinod Kumar, Mohit Bhatia, Arun H. S Kumar
DOI:10.4103/jnsbm.JNSBM_138_20  
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REVIEW ARTICLE Top

Transitional changes in cognitive-communicative abilities in adolescents: A literature review Highly accessed article p. 85
Malavika Anakkathil Anil, Jayashree S Bhat
DOI:10.4103/jnsbm.JNSBM_186_19  
Adolescence is a transitional phase requiring explicit attention to the changes in cognitive-communicative development. The foundation of cognitive-communicative development enables an adolescent to function at advanced language levels by not only mastering the preliminary skills of developing language but also learning language required for intensive social interactions. Adolescence comprises several challenging situations and tasks that may impact the overall well-being of adolescents by exposing them to a variety of conditions that can influence their decisions and lifestyles, all of which are heavily reliant on cognitive-communication. Subsequently, the renegotiation and instability upsurge the possibility for both internal and external conflicts, making adolescents vulnerable. The cognitive-communicative changes influence not only the transitioning phase but also the entire life course, thereby making it critical to understand the cognitive-communicative changes that take place during adolescence. The review elaborates on the significant cognitive-communicative changes observed in adolescents and various factors that influence the process.
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ORIGINAL ARTICLES Top

Comparative study of procalcitonin and C-reactive protein in patients with sepsis Highly accessed article p. 93
Harsha Virendra Patil, Virendra Chandrashekhar Patil
DOI:10.4103/jnsbm.JNSBM_1_20  
Background: The early diagnosis and appropriate therapy of sepsis is a challenge in intensive care units in spite of the advances in critical care medicine. Aim of the study: The aim is to study and compare procalcitonin (PCT) and C-reactive protein (CRP) levels in patients admitted with the diagnosis of sepsis to the critical care unit. Materials and Methods: This was a prospective observational study conducted at the teaching hospital over a period of 1 year. All patients with evidence of sepsis were enrolled for this study and were underwent relevant history, laboratory biochemical and imaging investigations including PCT and CRP levels. Results: A total of 64 patients with the diagnosis of sepsis were enrolled in this study. A total of 43 (67.19%) were male and 21 (32.81%) were female. The mean and standard deviation for the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score was 18 (±7), Sepsis-Related Organ Failure Assessment (SOFA) score was 9 (±5), papillary thyroid cancer as 19.07 (±7.02 ng/ml), and CRP was 33.5 (±15.7 mg/l). About 56.25% of patients had PCT in the range of 2–10 ng/ml, 28.13% had >10 ng/ml, and 14.06% had between 0.5 and 1.9 ng/ml. A total of 43 (67.19%) patients had a positive culture for organisms and 21 (32.81%) had sterile with no growth on culture with P < 0.001. The mean (20.74 ± 7.13). PCT levels were significantly high in Gram-negative organisms compared to (9.71 ± 0.96). Gram-positive organisms with P < 0.02. APACHE-II score, SOFA score, and CRP had a positive correlation with serum PCT levels and negative correlation with creatinine, pH, Glasgow Coma Scale and PaO2level. Multivariate analysis revealed that the serum PCT level was better correlated with the variable of sepsis than to CRP (P < 0.01). Conclusion: The present study concludes that the PCT was statistically significantly correlated with the severity of sepsis, APACHE-II, and SOFA score than CRP. The higher level of PCT was associated with Gram-negative sepsis and mortality.
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Enhanced oral bioavailability of diltiazem by resveratrol in healthy human subjects: An open-label, two-period, sequential study p. 100
Bharagavi Latha Athukuri, Prasad Neerati
DOI:10.4103/jnsbm.JNSBM_163_19  
Background: The purpose of this study was to investigate the bioavailability enhancing potential of resveratrol (RSV) on diltiazem (DLT) treatment in healthy human volunteers. Materials and Methods: An open-label, two-period, sequential study was conducted in 12 healthy human male volunteers. A single dose of RSV 500 mg was administered daily for 10 days during the treatment phase. A single dose of DLT 30 mg was administered during the control phase and after treatment phases under fasting conditions. The blood samples were collected at predetermined time intervals after DLT dosing and analyzed using high-performance liquid chromatography. Results: Treatment with RSV significantly enhanced maximum plasma concentration, area under the curve, whereas the volume of distribution and apparent clearance (CL/F) of DLT was significantly decreased when compared to control. Conclusions: The results suggested that enhanced bioavailability of DLT might be attributed by bio enhancing the potential of RSV resulted by inhibition of P-gp and CYP3A4. Further, the dosage of DLT should be readjusted when it is used concomitantly with RSV supplements or food containing RSV.
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Evidence-based P-glycoprotein inhibition by green tea extract enhanced the oral bioavailability of atorvastatin: from animal and human experimental studies p. 105
Kiran Kumar Danaboina, Prasad Neerati
DOI:10.4103/jnsbm.JNSBM_201_19  
Background: The study aimed to explore the beneficial effects of green tea extract (GTE) on the permeability and absorption kinetics of atorvastatin in rats and healthy human volunteers. Methods: Wistar rats for both in situ and in vivo studies. In in situ Single pass intestinal perfusion study, three groups (n = 6), wherein Group 1 perfused with atorvastatin as control, Group 2 coperfused with verapamil, and Group 3 coperfused with GTE then the effective permeability of atorvastatin was determined. In in vivo study, three groups (n = 6), wherein Group 1 is treated with atorvastatin as control, Group 2 pre-treatment with verapamil for 7 days and Group 3 pretreatment with GTE for 7 days and on 8th day atorvastatin was repeated and subjected to pharmacokinetic study. These results were confirmed on 24 healthy human volunteers, the randomized crossover trial was carried with atorvastatin for 11 days to check the bioavailability of atorvastatin by pre-treatment with GTE. Blood samples collected between 0.5 and 24 h on day-1, following administration of atorvastatin. Blood sampling was repeated using similarly specified time intervals on day-11, after treating human volunteers with GTE capsule 400 mg for 10 days. Results: Effective permeability of atorvastatin has been increased by GTE in in situ studies. The clearance of atorvastatin was decreased by 17.5% (P < 0.001), and Cmaxwas increased many folds significantly in in vivo studies. A significant increase in serum concentrations of atorvastatin was observed from 1st h. Cmax, bioavailability were increased by 14.5% (P < 0.05), and 22.7% (P < 0.001), respectively, in human volunteers. Conclusion: Increased bioavailability of atorvastatin is due to the P-gp inhibition by GTE, leads to the reduced dose. Further anti-hyperlipidemic activity of the GTE enables the dyslipidemic patients to take this herbal product safely.
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Modulation of blood glucose, oxidative stress, and anxiety level by controlled vestibular stimulation in prediabetes p. 111
Remya Paul, JK Mukkadan
DOI:10.4103/jnsbm.JNSBM_205_19  
Introduction: Prediabetes is the state of intermediate hyperglycemia. The present study was conducted to analyze the effect of controlled vestibular stimulation (CVS) on blood glucose levels, oxidative stress, and anxiety levels in prediabetic patients. Materials and Methods: This randomized controlled study was conducted at Little Flower Hospital and Research Centre, Angamaly, Kerala. This study comprised 117 prediabetic patients divided into experimental and control groups. Anthropometric measurements, blood pressures, blood glucose levels, and oxidative stress parameters were estimated. State-Trait Anxiety Inventory questionnaire was used to measure the anxiety levels. CVS was provided to the patients in the experimental group using a swing with back to front direction for 3 months. The parameters were reassessed after 3 months of intervention. Comparisons of parameters were carried out by paired t-test, Wilcoxon signed-rank test, and multivariate regression analysis. Results: Blood glucose levels, malondialdehyde level, and anxiety levels were significantly decreased in the experimental group compared to the control group. There was a significant increase in the superoxide dismutase activity after the intervention compared with the control group. Conclusion: The present study confirmed the importance of cost-effective lifestyle intervention for prediabetic patients. CVS can be incorporated in the lifestyle to maintain optimum blood glucose levels and tackle oxidative stress and anxiety
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Multimodality of human epidermal growth factor receptor-2 antagonism restores the apoptotic capacity of liver cancer cells p. 118
Nahla O Mousa, Marwa Gado, Ahmed Osman
DOI:10.4103/jnsbm.JNSBM_183_19  
Background: Hepatocellular carcinoma, the most widespread form of liver cancer and one of the most common and lethal malignancies, is characterized by poor prognosis, late onset, and a lack of clear-cut diagnostic markers. Novel therapeutic approaches are desperately required to develop effective treatment regimens. Methods: In this study, we attempted to reverse the proliferative capacity of liver cancer cells through employing a 3 – prong approach. We evaluated the antitumorigenic effects of some medicinal plant extracts that contain bioactive phytochemicals. In addition, we used Imatinib – a tyrosine kinase inhibitor (TKI), with human epidermal growth factor receptor (Her2)-specific small interfering RNA(siRNA) species to counteract the Her2-induced proliferative capacity of cancer cells. In our model, we evaluated the extent of activation of apoptotic mechanisms versus the proliferative and antiapoptotic strategies mounted by cancer cells. Results: Our results showed that HepG2 cells treated with 0.5 mM Imatinib exhibited marked downregulation of Her2 expression, upregulation of the proapoptotic marker, BAX and a downregulation of proliferative markers GPC3 and transforming growth factor (TGF)-β (45, 29, 95, and 115 folds, respectively). In the meantime, there was also significant downregulation of Her2, TGF-β, Mcl1, Spp1, GLUL and GPC3 expression and activation of apoptotic system in the cells treated with a mixture of anti-Her2 siRNA, Imatinib along with some selected extracts where the mixture successfully decreased viability of cancer cells. Conclusion: our study reveals the potential of using TKI along with phytochemical therapy and RNA interference as adjuvant regimen for treatment of liver cancer to augment the efficacy of the current control programs, yet, minimizing the side effects by transition to targeted rather than mass therapies.
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Efficacy of sustained natural apophyseal glides mulligan technique on mobility and function in patients with cervical spondylosis: An experimental study p. 128
S Arul Pragassame, VK Mohandas Kurup, Jasmine Kour
DOI:10.4103/jnsbm.JNSBM_184_19  
Background: Cervical spondylosis is a degenerative condition that affects the joints and discs of the cervical spine. Symptoms include pain associated with a positional fault in the joint with resultant subtle biomechanical changes, such as joint restriction and stiffness. Sustained natural apophyseal glides (SNAGS) Mulligan technique shows a direct effect on the facet joints, helping to correct the positional fault and correct the biomechanical changes. Objective: The objective of the study is to find the efficacy of SNAG Mulligan technique on pain, mobility, and functional disability in patients with cervical spondylosis. Materials and Methods: Forty subjects with cervical spondylosis were selected on the basis of selection criteria. The pain intensity was measured using the Numeric Pain Rating Scale (NPRS), the cervical range of motion (ROM) was measured using the universal goniometer, and the functional disability was measured using the neck Bournemouth Questionnaire (BQ). Patients were randomly assigned to two Groups A and B. Group A (n = 20) received SNAG Mulligan technique along with conventional treatment and Group B received transcutaneous electrical nerve stimulation and isometric neck exercises (conventional treatment) alone. Results: Group A had significant improvements in NPRS (Z = 25.754, P = 0.001), cervical ROM flexion (Z = 17.085, P = 0,001), extension (Z = 17.962, P = 0.001), side flexion (Rt) (Z = 16.520, P = 0.001), side flexion (Lt) (Z = 16.998, P = 0.001), right rotation (Z = 15.379, P = 0.001), left rotation (Z = 13.180, P = 0.001), and neck BQ (Z = 22.912, P = 0,001) compared to Group B. Conclusion: The study concludes that patients who received SNAG Mulligan technique showed better improvement in pain reduction, cervical ROM, and functional disability than the control group.
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Evaluating the efficacy of platelet rich plasma injection for the treatment of chronic plantar fasciitis p. 135
Vetrivel Chezian Sengodan, Nandakumar Thiagarajan, Iniya Prasanna Raajendiren
DOI:10.4103/jnsbm.JNSBM_199_19  
Background: Plantar fasciitis is a common and recurring cause of heel pain in adults. Platelet-rich plasma (PRP) derived from autologous blood contains a high concentration of growth factors necessary for tissue healing and offer potential treatment for plantar fasciitis. Materials and Methods: The study was conducted in Coimbatore medical college hospital as a day care procedure. Between May and September 2017, 100 patients with chronic plantar fasciitis with a mean age of 40 years were included in this prospective study and were treated with single autologous PRP injection. All patients were assessed for the pain on the visual analog scale (VAS) and the American orthopedic foot and ankle score (AOFAS) both preinjection and postsingle injection of PRP. Results: The average pain perception before injection as assessed using VAS was observed to be 9.1. Before PRP injection, 72% of patients had severe limitation of activities and 28% of patients had moderate limitation of activities. Following the administration of PRP, VAS decreased to 1.6. Eighty-eight patients were completely satisfied; eight patients were satisfied with reservation, whereas four patients were unsatisfied with the treatment outcome. AOFAS improved from 52 to 90, thus establishing its therapeutic efficacy both at 8 weeks and 3 months posttreatment. Conclusion: The results of this study support that injection of autologous PRP is safe, does not affect the biomechanical function of the foot and is efficacious in improving plantar fasciitis.
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KRAS gene polymorphism (rs61764370) and its impact on breast cancer risk among women in kerala population, South India p. 140
MT Mohthash, Sunil Kumar Shah, Anand Thirupathi
DOI:10.4103/jnsbm.JNSBM_20_20  
Background: In association with the risk of developing different types of cancer, several studies have currently reported association of single-nucleotide polymorphisms in the lethal-7 miRNA binding site within the 3'-untranslated region of KRAS gene. The present study was conducted for assessing the role of KRAS gene polymorphism (rs61764370 T >G) and its impact on breast cancer (BC) risk among the Kerala population, South India. Subjects and Methods: A case–control study was conducted at two health-care centers in Kerala, South India, involving 112 BC patients and 112 healthy controls (females). Genetic analysis was performed to detect KRAS polymorphism (rs61764370 T >G) employing polymerase chain reaction–restriction fragment length polymorphism method. Odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the relationship of KRAS (rs61764370) polymorphism with BC susceptibility. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, version 21.0) software and MedCalc software (version 16.4.3). Results: The frequency distribution of KRAS (rs61764370) polymorphism was found to be different between case and control groups significantly indicating that the KRAS gene could play an important role in the pathogenesis of BC in South Indian population. The rs61764370 TG genotype (OR = 1.59; 95% CI = 0.87–2.92; P = 0.02), GG genotype (OR = 3.177; 95% CI = 1.34–7.48; P = 0.008), as well as the G allele (OR = 2.45; 95% CI = 1.32–4.57; P = 0.004) was found to increase the risk of BC among the studied South Indian population. Conclusion: The present study provided evidence regarding the role of KRAS polymorphism (rs61764370) in developing BC among the studied population. The KRAS rs61764370 variant was found to increase the BC risk among the South Indian population (Kerala). Further studies using larger sample sizes in different ethnicities are warranted to confirm the study findings.
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Immunohistochemical evaluation of nucleotide-binding and oligomerization domain 1 and nucleotide-binding and oligomerization domain 2 receptors in periodontal health and disease p. 145
CH Neeharika Rao, Lalitha Tanjore Arunachalam, Uma Sudhakar
DOI:10.4103/jnsbm.JNSBM_22_20  
Introduction: Periodontal disease, infectious in origin and inflammatory in progression ultimately leads to destruction of periodontium. Pattern recognition receptors (PRRs) help in identifying the molecular patterns displayed on the bacteria and mount an immune response. Nucleotide-binding and oligomerization domain receptors (NOD1 and NOD2) are cytosolic PRRs involved in the immunopathogenic process involved in the periodontal diseases. This study was undertaken to evaluate distribution of NOD1 and NOD2 and to compare and correlate the NOD1 and NOD2 expression in gingival samples from healthy, chronic, and aggressive periodontitis participants. Materials and Methods: Sixty participants participated in the study and were divided into three groups of 20 individuals each - Group I (healthy), Group II (chronic periodontitis), and Group III (aggressive periodontitis) based on the inclusion and exclusion criteria. Gingival tissue samples were collected during periodontal flap surgery, crown lengthening procedure in periodontitis individuals and healthy controls, respectively. The levels of NOD1 and NOD2 in the gingival samples were analyzed using immunohistochemistry. Results: The NOD1 and NOD2 levels were higher in Group III (aggressive periodontitis) followed by Group II (chronic periodontitis) and lowest in Group I (healthy). Comparison of mean NOD1 and NOD2 between the three Groups showed statistically significant difference (P < 0.001). Positive correlation was observed on correlating NOD1 and NOD2 with the clinical parameters (gingival index, probing pocket depth, and clinical attachment loss). Conclusion: Epithelial localization of NOD1 and NOD2 was more in periodontitis than in healthy tissue. These findings indicate that NOD1 and NOD2 play an indispensable role at the forefront in innate immunity.
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Vetrivel trauma score – An evidence-based scoring system to predict limb salvage and outcomes in gustilo anderson grade III B and C compound fractures of lower extremities p. 151
S Vetrivel Chezian Sengodan, V Arun, S Arun
DOI:10.4103/jnsbm.JNSBM_51_20  
Background: Open fractures with severe soft-tissue injuries are clinically challenging to treat. While several scoring systems are available to grade these clinical conditions, the Gustilo Anderson grading system is most commonly used. This grading system neither offers any clue regarding salvaging open fractures of Grade III B and above, nor does it help the surgeon to assess the outcomes in such injuries. Hence, a new system of grading was assessed to address this deficiency. Materials and Methods: Five hundred and twelve open fracture cases were analyzed for this study. Two hundred and twenty-seven patients sustained Grade III injuries according to the Gustilo Anderson classification; Of these, 175 patients had Grade III A open fractures and 52 patients were of Grade III B and above. The 52 patients with open fractures of Grade III B and above were scored using mangled extremity severity score (MESS), Ganga score, and our novel scoring system. The accuracy in deciding amputation and predict outcomes were measured. Results: The scores assessed by the new scoring system were compared with MESS, Gustilo grading, and Ganga score system. Binary logistic regression analysis indicated our scoring system to be more accurate compared to all other scoring systems (P = 0.02). A receiver operating characteristic curve was plotted to compare all other scoring systems. The area under the curve (0.996 ± 0.003) for our scoring system was significantly higher with the less standard error of the mean than other scoring systems compared. Conclusions: Our new scoring system was more accurate in predicting limb salvage and outcomes compared to the existing scoring systems for open fractures of Grade III B and above.
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Factors associated with maternal referral system in South India: A hospital-based cross-sectional analytical study p. 158
Tanveer Rehman, Anish Keepanasseril, Dilip Kumar Maurya, Sitanshu Sekhar Kar
DOI:10.4103/jnsbm.JNSBM_33_20  
Background: Availability of free/low-cost treatment in higher government facilities increases maternity self-referrals circumventing the referral system. We aimed to find the sociodemographic and health-care service delivery pattern among the pregnant women referred for institutional delivery in a tertiary care center in south India and assess factors associated with maternity self-referral from the perspective of pregnant women. Materials and Methods: We conducted a cross-sectional analytical study among pregnant women attending the antenatal clinic and admitted to the obstetric and postnatal wards during the 6-month study period. Interview was conducted using a face validated structured questionnaire. Statistical Analysis: Adjusted prevalence ratio (aPR) with 95% confidence interval (CI) was calculated to assess the independent effects of the sociodemographic and health-care delivery factors on maternity self-referral. Results: Mean age of 4191 pregnant women was 24 years (3.9). Forty-one percent (1732) of them had come without any referral, i.e., self-referred. Fifty-two percent (909) of these self-referred pregnant women were primigravida, 77% (1330) belonged to joint families and had nearest health facility within half hour distance from their own house. Nuclear family (aPR: 1.56 [95% CI: 1.45–1.68]), monthly family income >Rs. 3000 (aPR: 1.38 [95% CI: 1.28-1.49], and nearest health facility more than half-hour (aPR: 1.57 [95% CI: 1.45–1.69]) were factors significantly associated with self-referral. Conclusions: The study presents the alarming maternal referral system prevailing in nation as 41% (95% CI: 39.8%–42.8%) of maternal admissions in a tertiary care institute of South India were without any documented referrals.
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The prevalence and related risk factors of obstructive sleep apnea in heart failure patients at the indonesian referral hospital for respiratory diseases p. 164
Agus Dwi Susanto, Regina Annisa Harahap, Budhi Antariksa, Muhammad Abbas Basalamah, Fariz Nurwidya
DOI:10.4103/jnsbm.JNSBM_176_19  
Background: Obstructive sleep apnea (OSA) is closely associated with metabolic diseases such as hypertension and dyslipidemia. OSA is also frequently found in patients with heart failure. This study aims to determine the prevalence and factors which affect the incidence of OSA in patients with heart failure. Methods: This cross-sectional study was conducted on 70 samples of patients with heart failure in the cardiac outpatient clinic and inpatient ward of the Persahabatan Hospital, Jakarta, Indonesia. Results: Using the Berlin Questionnaire, 42 patients (60%) were found to be at high risk of OSA. Using the Chi-square test, it was found that age (P = 0.988), gender (P = 0.678), body mass index (P = 0.170), neck circumference (P = 0.605), abdominal circumference (P = 0.189), blood pressure (P = 0.922), and smoking (P = 0.678) factors did not have a significant correlation with OSA risk in patients with heart failure. While the tonsil size was found to have a significant correlation (P = 0.005). Conclusions: Patients with heart failure were at risk of having OSA, and tonsil size was significantly correlated with OSA incidence in patients with heart failure.
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How much is too much? Effect of volume on water-swallowing test p. 169
Thejaswi Dodderi, Mousira Puthiry, Soniya Thomas
DOI:10.4103/jnsbm.JNSBM_63_20  
Introduction: Water-swallowing test (WST) is a simple, economical bedside screening test practiced for early identification of risk for dysphagia (or swallowing impairment). However, there is no consensus on the right test quantity to assess swallowing ability by WST. Aim of the Study: The aim of the present study was to establish the right quantity of water for WST sufficient to assess sequential swallowing in healthy adults albeit avoiding larger quantity of thin liquids. Subjects and Methods: Thirty healthy young adults (HYA) (20–40 years) and thirty healthy middle-aged adults (HMA) (41–60 years) were enrolled by nonrandom convenient sampling. Four quantities (50, 90, 100, and 150 ml) of room temperature water was gauzed by a measuring cup and randomly presented to the participants to swallow in their natural pace. As per the test standard, volume/swallow (V/S), time/swallow (T/S), and swallow capacity (SC) indices were derived and subjected to further statistical analysis. Results: The results of the study suggested statistically significant increased V/S and SC in a lesser T/S among HYA compared to HMA, and the difference was at P < 0.05. The results also revealed 150 and 50 ml to have statistically significant highest and lowest SC, respectively, at P < 0.05. Pearson's correlation index suggested a positive correlation across swallowing indices between the four test volumes of water. Conclusion: The state of evidence suggests better swallowing performance in HYA, and also, there exists a direct relationship between the quantity of water and indices of WST. The advisory is to use the least of the four test quantity of thin liquids for the WST.
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Evaluation of paragonimus metacercariae isolated from Maydelliathelphusa Lugubris and morphological characterization of Paragonimus Westermani recovered from an experimental model p. 176
Bhamani Devi Tongbram, Takhellambam Shantikumar Singh, Dechen Chomu Tsering
DOI:10.4103/jnsbm.JNSBM_61_20  
Background: Humans acquire Paragonimus westermani (lung flukes) infestation by consumption of crabs and crayfish harboring Paragonimus metacercariae. This study was designed to evaluate the prevalence of P. westermani infection in fresh water crabs found in Manipur, India. The morphological characterization of adult fluke recovered from Wister rats infected with P. metacercariae was also studied. Materials and Methods: The freshwater crabs were collected from the mountain streams of Churachanpur district, Manipur, India. P. metacercariae were harvested from the crab extract under a stereomicroscope. To recover adult flukes, twenty P. westermani-type metacercariae were injected intraperitoneally to Wister rats. The adult fluke recovered from Wister rats were stained with borax carmine, and the whole mount was used for morphological assessment. Results: Crabs of species, Maydelliathelphusa lugubris, were found to harbor Paragonimus heterotremus- and westermani-type metacercariae. Two migratory flukes were recovered from the lung surface of the Wister rats injected intraperitoneally with metacercariae. The morphological features of the mounted specimen of adult fluke recovered showed six lobed ovaries with terminal branching and five lobed testes. On the basis of the morphological features, the species was identified as P. westermani despite the atypical features of its metacercariae. Conclusion: Here, we report the role of M. lugubris fresh water crab species as natural permissive hosts of lung fluke (P. westermani) in Manipur region of India.
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MINI SERIES ON MICROBIAL AND DENTAL PROBLEMS Top

Comparison between oral health status of institutionalised and home stay disabled children in western Maharashtra region p. 179
Pallavi Sharad Suryarao, Namrata Nishant Gaonkar, Prerana Vinod Hariyani, Darshan Wable, ND Shashikiran
DOI:10.4103/jnsbm.JNSBM_27_20  
Background: Parents and caregivers of differently-abled children while focusing on the primary medical issues may not pay adequate attention to their dental care. In this study, we assessed and compared the oral health status of differently-abled children (aged 7–17 years) from structured institutionalized versus home care conditions in the Western Maharashtra region, India. Materials and Methodology: The study consisted of 100 differently-abled children (aged 7–17 years), each under structured institutionalized or home care conditions. For each child, decayed, missing, and filled teeth (DMFT) and decayed, extracted, or filled deciduous teeth (deft) index and oral hygiene status were assessed. Results: Differently-abled children under structured institutionalized care showed lower caries experience in both primary and permanent teeth as compared to differently-abled children who were under home care conditions. Conclusions: The DMFT/deft score was less in Group B compared to Group A. The overall oral hygiene was poor in both groups. Educating the parents and primary caregivers on improving the dental care of differently-abled children is necessary.
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Knowledge and attitude of school teachers toward thumb-sucking habit in children p. 183
Vinod Birra, Mathai Thomas, Kranti Kiran Reddy Ealla, Vinod Kumar, Sowmya Marri, Durga Prasad Mudrakola, Veena Shivanna
DOI:10.4103/jnsbm.JNSBM_132_19  
Background: Thumb sucking is the most prevalent oral habits among toddlers infants and children. Children spend considerable amount of time in school. Hence, school teachers, especially primary school teachers can play an important role in developing health habits in their students. There are lack of studies on the assessment of teacher's knowledge and attitude about thumb-sucking habit. Aim: The study was undertaken to determine the knowledge and attitude of school teachers toward thumb-sucking habit in children. Methodology: Pretested questionnaires that involved paper and pen were distributed to the study participants in person and the filled questionnaires were collected on the same day. Then, the completely filled questionnaires were statistically analyzed using descriptive statistics (percentage). Results: Many respondents were unaware of thumb-sucking habit. High percentage of the study participants adopted similar methods to stop thumb-sucking habit in school children. Many teachers indicated that the Internet was the leading source of information about thumb-sucking habit. Furthermore, many teachers were willing to learn more about the prevention and management of the thumb-sucking habit. Most of the study participants felt that counseling of parents and child is very important to stop the habit. Large percentages of teachers were unaware of the role of the dentist in the management of thumb-sucking habit and its associated malocclusion. Conclusion: In this study, the primary school teachers lack the knowledge about thumb-sucking habit in children and their attitude was also found to be unsatisfactory. They need educational programs and symposiums to update their knowledge about the pernicious oral habits.
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Ceftriaxone-sulbactam-EDTA susceptibility profile of multi-drug resistant gram-negative bacterial isolates: Experience from a tertiary care teaching hospital in Rishikesh, Uttarakhand p. 189
Manisha Paul, Mohit Bhatia, Anusha Krishna Raj, Amit Mangla, Balram Ji Omar, Pratima Gupta
DOI:10.4103/jnsbm.JNSBM_64_20  
Introduction: Studies have shown that ceftriaxone-sulbactam-EDTA combination is a promising therapeutic option as carbapenem sparer in cases of infections caused by ESBL and MBL producing pathogens, respectively. This study is aimed to generate preliminary data on in-vitro susceptibility profile of clinical multi-drug resistant (MDR) Gram-negative bacterial isolates to ceftriaxone-sulbactam-EDTA combination. Materials and Methods: A cross-sectional study was conducted from January 1st, 2019 to October 31st, 2019. Antibiotic susceptibility data (including that of ceftriaxone-sulbactam-EDTA combination) of 200 multi-drug-resistant Gram-negative bacterial isolates obtained from various nonrepetitive clinical samples of patients of all age groups and sexes, was retrospectively analyzed. All clinical samples were processed aerobically as per standard guidelines, and the bacterial isolates obtained in culture were identified by conventional biochemical methods. Antibiotic susceptibility testing of bacterial isolates was performed using the modified Kirby Bauer disk diffusion method, the results of which were interpreted as per the Clinical and Laboratory Standards Institute (CLSI) guidelines 2019. In vitro susceptibility test results of ceftriaxone-sulbactam-EDTA combination, disks were interpreted as per the manufacturer's instructions. Results: Acinetobacter spp. was the most common isolate (53%), followed by Escherichia coli (20.5%), Klebsiella spp. (17.5%), Pseudomonas aeruginosa (16.5%), Citrobacter spp. (2%), and Proteus spp. (1%), respectively. 99.1%, 92.7%, 88.6%, and 69.3% of Acinetobacter spp., E. coli, Klebsiella spp. and P. aeruginosa, respectively, were susceptible to ceftriaxone-sulbactam-EDTA combination disks. Conclusions: The preliminary data generated by our study could be an eye-opener for clinicians practicing in this part of the country and should prompt further investigation in the form of clinical trials.
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Uncovering physical interactions among human and Mycobacterium tuberculosis proteins p. 194
Dhammapal Bharne, Bhagyashri Tawar, Vaibhav Vindal
DOI:10.4103/jnsbm.JNSBM_3_20  
Background: Pathogens usually evade and manipulate host immune pathways through host-pathogen protein interactions. Uncovering these interactions is crucial for determining the mechanisms underlying pathogen infection and the defense system. The growing prevalence of tuberculosis (TB) infection in the world necessitated advances in TB research. With the rising information from several divisions of biosciences, computational approaches are promising to analyze and interpret the data at the system level. Methods: In the present study, in silico two-hybrid systems is employed on model organisms to predict physical interactions among proteins of Human and Mycobacterium tuberculosis (Mtb). Consistent protein interactions are identified by the Interlog method. Co-expression analysis and functional annotations are performed to infer significant Human and Mtb protein physical interactions (HMIs). Results: The interactions identified in this study support the current TB research through an improved understanding of the pathogen infection and survival mechanism. A network of HMIs highlighted dnaK as the most highly interacting protein. Further, dnaK, eno, tuf, and gap proteins are found to trigger toll-like receptor signaling pathways and initiate pathogenesis. Conclusion: The interactions proteins identified in this study may incline the researchers to explore for novel therapeutic intervention strategies.
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Studies on phytoconstituents, In vitro antioxidant, antibacterial, and cytotoxicity potential of Argemone mexicana Linn. (Family: Papaveraceae) p. 198
Kailas D Datkhile, Satish R Patil, Madhavi N Patil, Pratik P Durgawale, Nilam J Jagdale, Vinit N Deshmukh
DOI:10.4103/jnsbm.JNSBM_56_20  
Background: The present study was designed to determine the antioxidant, antimicrobial, and cytotoxic activity of Argemone mexicana. Materials and Methods: Aqueous, methanol, and ethanol extracts of the whole plant A. mexicana were screened for phenolics, tannins, and flavonoids. The in vitro antioxidant activity was evaluated through 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid), 2,2-diphenyl-1-picryl -hydrazyl-hydrate, and ferric reduction activity potential assays. The antimicrobial activity of the extracts against Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus was determined. Cytotoxic properties of the extracts were studied using the cancer cell lines HeLa, MCF-7, and HCT-15 through cell viability and DNA fragmentation assays. Results: Phytochemical analysis revealed that the extracts contained phenolics, tannins, and flavonoids. The aqueous and solvent extracts of the whole plant exhibited a strong antioxidant activity in vitro and antibacterial activity against the tested human pathogenic bacteria. The crude extract of A. mexicana exhibited a strong cytotoxic activity against the tested cancer cell lines. Conclusion: Phytoconstituents from the crude extract of A. mexicana exhibited higher antioxidant, antibacterial, and cytotoxic activities than earlier reported annotations.
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CASE REPORT Top

Speech-language profile of a child with fahr's disease: Case report of a rare neurodegenerative disorder p. 206
Malavika Anakkathil Anil, Rachel Melrita Rebello, Jayashree S Bhat
DOI:10.4103/jnsbm.JNSBM_178_19  
Fahr's disease is a rare, neurodegenerative disorder characterized by abnormal deposits of calcium in areas of the brain that control movement. Cases of Fahr's disease in young children are rarely seen, and limited literature is available on speech and language manifestations. The present case report highlights the early speech and language manifestations of Fahr's disease in a 6-year-old female child. The child presented with deficits in oro-motor functions, with articulatory errors and reduced intelligibility of speech. The oro-motor movements were observed to be slow and sluggish. Language assessment revealed reduced vocabulary and delay in expressive language. Early literacy skills were seen to be emerging. Although the deficits in young children look subtle in comparison to the myriad complications exhibited by adults, the findings have substantial clinical implications. This article expands our understanding of Fahr's disease in children, its nature and onset, early signs and symptoms, assessment protocols to be used, and the possible management strategies. These findings can help researchers, students, and clinicians in clinics as well as research.
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