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   Table of Contents - Current issue
July-December 2021
Volume 12 | Issue 2
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Self-reliance in advanced diagnostic imaging for accessible, affordable, and quality health care in India p. 129
Vinod Kumar, Arun H.S Kumar
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Biochemical role of zinc in dengue fever Highly accessed article p. 131
Thaksha L Poojary, K Sudha, K Sowndarya, Reshma Kumarachandra, Y Durgarao
Background: Zinc is an essential trace element that has been shown to play a crucial role in viral infections. As a part of RNA polymerases, zinc helps in the replication of many viruses. Cholinesterases are low-grade inflammatory markers that have zinc-dependent carboxypeptidase activity. Plasma butyrylcholine esterase is an indicator of dietary zinc level. Matrix metalloproteinases (MMP) that participate in inflammatory processes and contribute to tissue remodeling and repair are zinc containing endopeptidases. The present study attempts to establish the association of zinc with these enzymes in dengue. Materials and Methods: Plasma zinc, butyrylcholinesterase (BChE), and erythrocyte acetylcholinesterase (AChE) were estimated spectrophotometrically in 100 dengue patients and 50 healthy controls. MMP9 was determined using ELISA. Results: Plasma zinc was markedly lower in dengue fever patients compared to healthy controls (P < 0.05). Both BChE and AChE decreased significantly in these patients (P < 0.001) compared to healthy controls. There was an elevation of MMP9 in dengue, although the increase was statistically insignificant. Cholinesterases and MMP9 correlated positively with zinc in controls and dengue, although the correlation was statistically insignificant. Conclusion: The study highlights the role of zinc in the pathology of dengue, as it is essential for the maintenance of activities of cholinesterases and MMP9 that are involved in anti-inflammatory and tissue remodeling processes. Further, prompt administration of micronutrients like zinc may reduce the adverse manifestations and morbidity in dengue.
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Intravenous magnesium sulfate and isoxsuprine for arrest of preterm labor: A comparative study Highly accessed article p. 135
Rohit Jeswani, Yamini Patil, Sanjay Patil
Background: Despite advances in obstetrics and neonatal care, the rate of incidence of preterm births continues to increase. Use of tocolytic agents such as magnesium sulfate and isoxsuprine could help in arresting preterm labor. Considering the paucity in studies comparing these two agents, a comparative analysis is obligatory. Objective: The objective of the study was to compare the safety, efficacy, and success rate of magnesium sulfate and isoxsuprine in the arrest of preterm labor. Methodology: Eighty-two antenatal women belonging to 28–37 weeks of gestational age, with regular uterine contractions, cervical dilatation (≤3 cm), and <50% cervical effacement admitted with complaints of preterm labor pain were randomly allocated into two groups with 41 participants in each group. Group 1 received 40 mg isoxsuprine for 24 h and later, isoxsuprine capsule 40 mg was given orally twice a day for 7 days, and Group 2 received 4 g magnesium sulfate for 12 h if uterine quiescence was achieved by the end of 2 h. Demographic data, medical history, and clinical data were collected. The outcome variables measured included side effects and the success rate (effacement% and cervical dilatation). Statistical analysis was performed using R software (Version 3.6.0). Results: The majority of the patients in both the groups with <25% effacement had successful tocolysis (P > 0.05). In Group 2, patients with <1 cm of cervical dilatation had successful tocolysis compared to Group 1 (P < 0.05). A highly significant association was observed between the percentage of effacement and cervical dilation, successful tocolysis (P < 0.001). Tachycardia and hypertension were observed more in Group 1, whereas nausea and vomiting were common in Group 2. The overall success rate was better in Group 2 (85.37%) compared to Group 1 (65.85%). Conclusion: Magnesium sulfate was slightly more effective in arresting preterm labor with lesser side effects as compared to isoxsuprine.
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Cullin 1 as a proangiogenic factor and its relationship with vascular endothelial growth factor and p21 are associated with the length of gestational age of pre-eclampsia p. 140
Tjam Diana Samara, Heri Wibowo, Isabella Kurnia Liem, Ani Retno Prijanti, Andrijono
Background: Cullin 1 (CUL1), vascular endothelial growth factor (VEGF), and p21 are proteins that play a role in pregnancy. CUL1 and VEGF are proangiogenic factors, whereas p21 is an antiangiogenic factor. An imbalance between proangiogenic and antiangiogenic factors is one of the various factors that cause pre-eclampsia (PE). The aim of this study was to analyze CUL1 levels in the relationship with VEGF levels and p21 levels based on gestational age at delivery in PE. Materials and Methods: This was a cross-sectional study of 70 placentas from PE patients divided in two groups of gestational age at delivery: <34 weeks and ≥34 weeks. Levels of CUL1, VEGF, and p21 were examined by the enzyme-linked immunosorbent assay technique. Statistical analysis was assessed by Spearman correlation test and Chi-square test, with a significant P < 0.05. Results: Low levels of CUL1 and low levels of VEGF were related with <34 weeks of gestational age at delivery, whereas high levels of CUL1 and high levels VEGF were related with ≥34 weeks of gestational age at delivery. There was a negative correlation between the high ratios of p21/CUL1 and <34 weeks of gestational age at delivery in PE. Conclusions: Low levels of CUL1 and low levels VEGF and high ratios of p21/CUL1 were associated with <34 weeks of gestational age at delivery in PE.
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PAP smear versus colposcopy in symptomatic women and women with suspicious-looking cervix p. 145
Archana Rokade, Nitin Kshirsagar, Manisha Laddad
Objective: The aim of the study was to compare alternatives to human papillomavirus test, such as Papanicolaou (PAP) smear and colposcopy with histopathology in symptomatic women and those with suspicious-looking cervix. Materials and Methods: This prospective, 7-month study was conducted on 208 female patients aged ≥18 years with suspicious-looking cervix, complaining of vaginal discharge and menstrual bleeding. All patients were subjected to PAP smear, colposcopy, and colposcopy-directed biopsy. Sensitivity, specificity, and diagnostic accuracy were calculated to assess the performance of diagnostic tests. Data were analyzed using Fisher's exact tests using software R version 3.6.0. Results: Majority (166) of the patients were in the age group of 31–50 years (79.8%) and the mean age was 39.8 ± 7.9 years. Most of them had abdominal pain (65; 31.2%), white discharge (60; 28.8%), and early sexual exposure at 16–19 years (120; 57.6%) of age. PAP smear cytology revealed high-grade squamous intraepithelial lesion and low-grade squamous intraepithelial lesion (LSIL) in 4.3% and 5.8% women, respectively. Per speculum evaluation revealed cervical abnormalities in 85.6% of women. On colposcopy, low-grade infection and suspicious malignancy were noted in 28.8% and 14.4% women, respectively. The sensitivity and specificity of PAP test were 19.5% and 83.3%, respectively, whereas the corresponding values for colposcopy were 90.2% and 72.8%, respectively. Conclusions: PAP smear cytology demonstrated very poor sensitivity compared to colposcopy, especially for LSILs.
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A novel behavioral model in initiation and sustenance of toothbrushing behavior among dental and medical students in India: an exploratory analysis p. 149
Dhiraj Panjwani, Mithun BH Pai, Shweta Yellapurkar, Aayush Anand Poddar, Gururaghavendran Rajesh, Manoj Sharma
Purpose: Toothbrushing holds key importance in practical, competent, and efficacious design to limit the formation of dental plaque on the dental tissues, in turn, leading to a decrease in dental diseases. The recent addition to this growing knowledge in health behavior research is the multi-theory model (MTM) which addresses two crucial modules of health behavior: initiation and sustenance. In spite of reinforcing the habit of brushing twice daily, a lack of sustenance is found among young adults; hence, the objectives were to explore the substratal structure of MTM and to test the fit of MTM questionnaire in dental and medical students in India. Methodology: A questionnaire aimed at addressing sociodemographic information and MTM was designed. Reliability analysis was performed and explorative analysis was done using principal component analysis as the factor extraction method. Construct validity was investigated using exploratory factor analysis (EFA) to add a level of statistical. Results: Reliability analysis revealed a Cronbach's alpha value of 0.892 and split-half reliability value of 0.779. Test–retest reliability was found to be 0.77 (P < 0.01). Guttman split-half reliability was found to be 0.677. EFA suggested seven domains. Indices for model fit showed good fit with P < 0.01. Conclusion: The present study concludes that the Indian version of MTM is a reliable and valid instrument for measuring the initiation and sustenance of toothbrushing behavior in dental and medical students in India.
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Retention and caries preventive effect of GC fuji VII sealant on the first permanent molars among high-risk residential school children - A three year follow up study p. 155
Brinda Suhas Godhi, Raghavendra Shanbhog, B Nandlal, S Rashmi, Arun Gopi
Objective: The objective of the study is to seal the permanent first molars in high-risk children aged 7–8 years with GC Fuji VII and evaluate its retention and caries preventive effect over 3 years. Methodology: The present study was a longitudinal, randomized, interventional trial with a sealant and control group. 538 residential schoolchildren with high caries risk received sealants. 495 day scholars did not receive sealant formed the control group. Children of both the groups were evaluated annually for sealant retention and development of caries for 3 years. Independent sample t-test and Chi-square test were used to compare the sealant retention and caries incidence rates. Kaplan–Meier survival analysis and log-rank test were performed to compare the cumulative molar survival and sealant retention rates over 3 years. Results: Comparison of baseline oral health characteristics between sealant and control group revealed no statistically significant variation (P > 0.05). At the end of 3 years, total retention was 43.4% (n = 178), 45.9% (n = 188), 44.9% (n = 184), and 44.4% (n = 182), respectively. Cumulative mean incidence of dental caries at the end of 3 years showed statistically significant higher caries incidence among control 2.15 ± 3.33 as compared to sealant 0.25 ± 0.85 with mean difference of 1.90 (P = 0.001). Conclusion: School-based sealant program targeting low socioeconomic, high caries risk population can form comprehensive approach for caries-free generation. GC Fuji VII may be a better choice for preventing dental caries in school-based sealant program.
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Psychosocial burden of addiction: A study in correlation to urinary cotinine levels in tobacco chewers p. 161
Kiran S Nikam, Kanchan C Wingkar, Rajendrakumar Katte, Rajesh K Joshi, Rajashekar K Kallur
Background: Tobacco usage is a foremost avoidable risk factor for the progress and development of the psychological disease, its deleterious psychological effects through multiple mechanisms.To find out psychosocial impact in correlation to urinary cotinine levels of tobacco chewers (TC) and non tobacco chewers (NTC). Materials and Methods: A total of 600 TC and NTC (18–65 years) were studied using the Hamilton anxiety (Ham-A) and Hamilton depression (Ham-D) scale, Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST) scale, and structured questionnaire. Results: Psychosocial response by anxiety and depression scale for NTC and TC mean score comparison was found to be highly significant (P < 0.001). The mean urinary cotinine value in TC was increased as compared to the NTC group. Correlation of urinary cotinine levels with Ham-A, Ham-D, and FTND-ST was found significant (P < 0.001). The receiver operating characteristic curve for predicting optimal scores for FTND-ST was 4.5 and 16.5 for anxiety and depression. Conclusion: This is the first report from Belgaum which illuminates the linkage between tobacco chewing, psychological health risk factors, and addiction burden with urinary cotinine levels.
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Clinical evaluation of acute respiratory distress and chest wheezing in infants p. 165
GG Joag, Megha Rustagi
Background: Differentiating acute respiratory distress and wheezing in infants is difficult due to similar clinical presentations. Therefore, it is of utmost importance to diagnose and differentiate bronchopneumonia, bronchiolitis, and bronchial asthma on the basis of clinical parameters in infants. Materials and Methods: One hundred infants with fever, cough, and increased respiratory distress with wheezing were included, and detailed clinical history, allergic disorder, immunization status were collected. Study cases were diagnosed as bronchopneumonia, bronchiolitis, or bronchial asthma based on clinical criteria, and a suitable treatment regimen was provided. Chi-square test, Fisher's exact test, and two-sample proportion test were used to analyze the data. Results: Among 100 cases, 50% of cases were of bronchopneumonia, whereas 36% and 14% of cases were of bronchiolitis and bronchial asthma. A significant difference was observed among them for the history of wheezing (P = 2.839e-12), presentation of various signs and symptoms (P = 0.00), and treatment regimens. The odds of occurrence of bronchopneumonia was more with the signs of flaring of alae nasi and palpable liver (OR=[0.62–4.32]; and [0.63–4.14]). For bronchiolitis also, it was higher if they showed signs of tachycardia, pallor, and reduced breathing sounds (OR = [0.96–6.8679]; [0.44–2.76]; and [0.70–5.44]). Furthermore, for bronchial asthma, it was higher if it presented the signs of tachycardia, cyanosis, reduced breathing sounds, palpable spleen, etc., (OR = [0.90–16.18]; [1.93–36.50]; [0.43–6.92]; and [0.17–11.52]). Ampicillin and gentamicin treatment regimen for bronchopneumonia; salbutamol and intravenous fluids for bronchiolitis; and steroids and salbutamol for bronchial asthma were the choice of treatment. Conclusion: The study demonstrated the differential diagnosis of bronchopneumonia, bronchiolitis, and bronchial asthma based on clinical features and will be useful in the rational management of these conditions.
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Seroprevalence of TORCH-S infections among pregnant woman: A study from vellore district (South India) p. 170
Prashanth Rajendiran, Nithiyanandan Saravanan, Mageshbabu Ramamurthy, Sathish Sankar, Nancy David, Aravindan Nair, Rajasekar Aruliah, Balaji Nandagopal, Gopalan Sridharan
Introduction: TORCH-S agents include Toxoplasma gondii, Rubella virus, Cytomegalovirus, Herpes simplex virus (HSV) (1 and 2), and Treponema pallidum (syphilis) which are transmissible in utero at various stages of gestation. Description of the Hypothesis Tested: TORCH-S agents are known to cause adverse fetal outcomes and pregnancy loss. The Approach Used: Pregnant women attending a multispecialty hospital for regular antenatal care and high-risk pregnant women with a bad obstetric outcome from a rural area of Vellore District were recruited. A total of 180 pregnant women recruited from two centers were used. Pregnant women were evaluated for their serological status (IgM and IgG) against TORCH-S agents using commercial enzyme-linked immunosorbent assay kits available for respective pathogens. Results: Among the samples (n = 180) collected, IgM antibodies were positive in 3 (1.66%) for Toxoplasma gondii and 1 (0.55%) for HSV1. IgG antibodies were positive in 14 (7.77%) women for T. gondii, 152 (84.44%) for Rubella virus, 110 (61.11%) for CMV, 125 (69.44%) for the HSV-1 (16.66%), 30 were positive for HSV-2, and 5 (2.77%) women were positive for Treponema pallidum. In the 17–25-year age group, the number of IgG positives for T. gondii and HSV-2 were lower compared to other pathogens. Conclusions: The study reports a high prevalence of IgG to TORCH-S agents in pregnant women indicating a high risk among these populations. Routine screening for TORCH-S agents among antenatal women is warranted as timely diagnosis, and proper intervention could help initiate appropriate management. Information of these infections could help the clinicians for appropriate counseling on the potential for adverse fetal outcomes and preventive measures to the mothers.
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Single-nucleotide polymorphisms in genes associated with drug resistance of Plasmodium vivax in two regions of South India p. 175
G Mukthayakka, Annapurna G Sajjan, Ragini Ananth Kashid
Background: Plasmodium vivax is reported to be the predominant cause of malaria in India. Recent emergence of resistance to chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) drugs has been attributed to multiple mutations in pvmdr-1 and pvdhfr regions of P. vivax, respectively. Hence, in this study, we have assessed the single-nucleotide polymorphisms (SNPs) in pvmdr-1 and pvdhfr genes for CQ and SP drug resistance, respectively, in cases of malaria from two regions of South India. Materials and Methods: A total of 36 P. vivax isolates from Bengaluru and Vijayapura were collected and sequenced for pvmdr-1 and pvdhfr genes, and the SNPs were analyzed. Results: Out of the total 45 positive P. vivax samples assessed in this study, 36 samples were mono infection cases. No wild-type pvmdr-1 gene was observed in any of the samples analyzed. Predominant presence (83.3%) of double mutations (T958M and F1076L) was observed. In the pvdhfr gene, wild-type (36.1%) and two mutations (41.6%; S58R and S117N) were observed. New mutations were not detected in pvmdr-1 or pvdhfr gene in this study. Conclusion: The present study reports the presence of SNPs in both pvmdr-1 and pvdhfr genes in P. vivax isolates from Bengaluru and Vijayapura. Continuous monitoring of drug resistance to antimalarial drugs is essential for undertaking optimal public health measures tailored to selected regions.
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The impact of tumor necrosis factor-α (-308 G/A) and transforming growth factor beta 1 (-509C/T) gene polymorphism in Egyptian children with primary nephrotic syndrome p. 180
Rehab Elmougy, Afaf Elsaid, Nivin Salah
Background: Nephrotic syndrome (NS) is a disease affecting both children and adults. Cytokines act as inflammatory mediators in childhood NS. Excretion of too much protein in patients' urine as well as reduction in albumin levels in their blood are the most common symptoms of NS. Aim of the Study: The aim is to assess the potential relationship of tumor necrosis factor (TNF)-α (308 G/A) and transforming growth factor beta 1 (TGF-β1) (509C/T) genes with the incidence of NS. Subjects and Methods: In this study, 99 healthy children and 98 children with NS have been included. Polymerase chain reaction was used to detect the gene polymorphism of both TNF-α-G308A and TGF-β1 (509C/T). Results: The TNF-α G308A showed a significant different genotype distribution among children with NS compared with the healthy volunteers (GG vs. AA, P = 0.0009; [odds ratio [OR] 95% CI = 25.2 [2.45–259.23]); GG vs. GA, P = 0.001; (OR 95% CI = 4.84 [1.74–13.5]); as well as alleles distribution of G vs. A, P = 0.022; (OR 95% CI = 1.06 [1.068–2.42]). However, there is a non-significant variation in the frequency of TGF-β1 (-509C/T) genotypes (CC, CT and TT) respectively (11.4%, 78.5% and 10.1) in NS patients, compared with their corresponding levels in healthy control subjects (15.5%, 68% and 16.5). Conclusion: TNF-α-G308A polymorphism may help to early predict the incidence of NS in children, while TGF-β1 showed no effect on the disease incidence.
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Lymphocyte subset alterations in childhood iron deficiency anemia: A case–control study from Northern India p. 185
Nimisha Dhankar, Richa Gupta, Shramana Mandal
Background: The impact of iron deficiency anemia (IDA) on innate immunity is well documented, but the data on its effect on cells of the adaptive immune system are scant. The aim of this study was to assess peripheral blood lymphocyte subsets in children with IDA using flow cytometry. Materials and Methods: The total and differential lymphocyte populations of 80 iron-deficient children and 40 controls were assessed using a single-tube flow cytometry panel. Results: Children in the IDA group showed a significant decrease in total leukocyte count as compared to controls (P = 0.03). The study also found a significant increase in total lymphocytes and CD19 + B cells (P = 0.042 and 0.040, respectively). CD3, CD4, CD8, and NK cells were unaltered. Conclusion: The study concluded that iron deficiency in children is associated with relative lymphocytosis contributed mainly by the B lymphocytes. There is no quantitative defect in cells of the adaptive limb of the immune system in IDA. In view of the increased incidence of infections in these children, functional assays for identifying qualitative defects may prove useful.
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Concentration of chromium and nickel in serum of patients with orthopedic implant: An analysis p. 189
Vetrivel Chezian Sengodan, PJ Sai Sarrvesh
Introduction: Surgical corrections of fracture using fixation devices made from various alloys (stainless steel, cobalt-chromium alloys, and titanium) carry a risk of these alloys leaching into circulation, potentially causing undesired health effects. Hence, monitoring the levels of metal ions in the serum of postoperative patients with metal implants is mandated. Materials and Methods: Blood samples from seventy patients with orthopedic metal implants was collected after a minimum postoperative period of 1 year. The samples were subjected to triple acid digestion and serum levels of chromium and nickel were analyzed using inductively coupled plasma-mass spectrometry. Results: The concentration of chromium (0.13 ± 0.06 μg/L) and nickel (0.39 ± 0.28 μg/L) in serum was within the reference range (chromium: 0.05–0.15 μg/L; nickel: 0.05–1.0 μg/L). Although a relatively high variability in the concentration of nickel was observed compared to chromium. In a subgroup analysis, the concentrations of both metal ions were not influenced by either gender, age groups, site of intramedullary nail, or postoperative duration. Conclusion: The concentration of chromium and nickel in serum of patients with orthopedic metal implants was within the normal reference levels at over 1-year post implant. The concentration of these metal ions was not influenced by gender, age groups, site of intramedullary nail, or postoperative duration.
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Analysis of functional outcome of management of scaphoid waist fractures with herbert screw fixation p. 193
V Thirunarayanan, T Sivabalan, S Cheralathan, M Ravi, S Siva Shankar
Introduction: Fractures of the scaphoid bone mainly occur in young adults and constitute 70%–80% of all carpal bone fractures. The aim of our study was to assess the functional outcome of undisplaced and minimally displaced scaphoid fractures with percutaneous Herbert screw fixation. Materials and Methods: We conducted a prospective study from 2016 to 2018 including patients of more than 18 years of both sexes with waist fractures of scaphoid excluding avulsion fractures and compound injuries. The functional outcome of patients was assessed with the Modified Mayo Wrist Score (MMWS) at a minimum of 1-year follow-up. Results: Fifteen patients (M: F = 12:3) with a mean age of 39.4 years were enrolled in the study. The mean time to surgery after trauma was 5.75 days. Union was achieved in all the cases at a mean duration of 7.2 weeks; 93.3% (n = 14) of patients showed an excellent outcome, while the other 6.7% (n = 1) showed a good outcome with an average MMWS score of 92.6. Patients were able to reach this functional status as early as 3 months. The average duration of follow-up was 15 months. No major complications were encountered. Conclusion: Percutaneous Herbert screw fixation of scaphoid waist fractures provides excellent functional results enabling the patients to return to the preinjury status as early as 4 months without major complications.
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Functional and radiological outcome of single-stage surgical treatment of late presenting developmental dysplasia of the hip p. 198
Yada Bhanu Tej, Atmananda S Hegde, Chethan B Shetty
Background: Developmental dysplasia of the hip (DDH) is the second-most common pediatric orthopedic condition in our country. The management of children presenting with DDH in the walking stage is primarily by surgical approach due to the changes in the femoral head, acetabulum, and other soft tissues surrounding the joint. This study evaluated the functional and radiological outcome of children with DDH in the walking age group who underwent open reduction with or without femur or pelvic osteotomy. Materials and Methods: Retro-prospective Cohort Study was conducted in tertiary care hospital. All children underwent open reduction through a standard anterior approach. The hip was reduced, and stability was assessed intraoperatively, and osteotomy was performed. The functional and radiological outcome was assessed at the end of follow-up; various variables which influence the outcome were looked. Chi-square test was used to measure the association between the types of surgery with the outcome, Tonnis grade with the outcome, and these are expressed as frequency and percentage. Results: Sixty-six percent of hips in our study had excellent functional outcomes, 27% had a good outcome. About 68% of hips in our study had excellent, and 2.5% of hips in our study had a poor radiological outcome. Conclusions: The assessment of outcomes suggested that appropriate surgery based on age and intraoperative assessment will give satisfactory functional outcome, irrespective of whether acetabular/femoral procedures are done. The re-surgeries rate in our study was low as all of them had single staged combined surgical intervention.
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Merit of gait patterns for early detection of risk of falls among elderly participants: A comparative analysis from India p. 203
Vetrivel Chezian Sengodan, Hisham Abubeker, Anjana Muralidharan Pillai
Background: The aim of this study was to compare the gait patterns among Indian elderly participants with younger adults and to assess if altered gait patterns can predispose to trivial falls among the elderly. Materials and Methods: Three hundred and twenty healthy volunteers were recruited for this study, out of which 160 individuals were young (aged 15–30 years) and 160 individuals were elderly (aged 50–65 years) participants. The following three important gait characteristics, i.e. the stride length, foot clearance, and stride velocity were assessed at our 3D motion analysis laboratory. Results: The elderly participants had a significantly reduced stride length/velocity and foot clearance when compared to the young. Stride velocity although reduced among the elderly participants was however within the normal lower range. Conclusion: Significant reduction in foot clearance is likely to contribute to the higher incidence of falls among the elderly participants. A routine practice to assess these gait parameters in outpatient clinics can be helpful in early detection of the risk of fall among the elderly participants.
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Serum levels of nitric oxide and its correlation with endothelial nitric oxide synthase gene expression among type 2 diabetic patients with or without hypertension: A comparative study in a tertiary care hospital of North East India p. 207
Bidhan Goswami, Swapan Sarkar, Bhaskar Bhattacharjee, Shauli Sengupta
Background: The serum nitric oxide (NO) data in Type 2 diabetes mellitus (T2DM) patients reported by different scientific literature are controversial. Some research articles reported increased NO levels in diabetes patients, whereas others reported the opposite. Hence, this study was designed to compare the serum NO levels in T2DM patients with or without hypertension among subjects reporting to the Diabetes Nutrition Clinic (DNC) of a tertiary care hospital of Tripura. Aims: The aim of this study was to estimate serum levels of NO among Type 2 diabetic patients with or without hypertension, to determine the endothelial NO synthase (eNOS) gene expression at the transcriptional level, and also to assess the correlation between serum NO and eNOS gene expression among the study subjects. Materials and Methods: This hospital-based cross-sectional study was conducted from March 2019 to February 2020 among 198 diabetic patients attending the DNC of a tertiary care hospital of Tripura. Estimation of serum NO was performed using the ELISA technique and eNOS gene expression was performed using the reverse transcription-polymerase chain reaction technique. All statistical analysis was done using SPSS software version 25. Results: This study was conducted among 98 type 2 diabetic patients having hypertension and 100 controls, i.e., type 2 diabetics without hypertension. The mean serum level of NO in diabetic patients with hypertension was 35.35 ± 13.65 μmoles/L, whereas in the control group, i. e., diabetic patients without hypertension, it was 89.83 ± 10.29 μmoles/L, which was statistically significant (P < 0.001). A significant correlation (P < 0.001) was also found between serum NO level and eNOS gene expression among the study subjects. Conclusion: In conclusion, significantly higher serum NO levels were observed among the T2DM patients without hypertension as compared to the T2DM patients having hypertension.
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Evaluation of triglyceride/high-density lipoprotein ratio as a surrogate marker for insulin resistance in healthy young males p. 213
K Sowndarya, Joel Abraham Joseph, Amya Shenoy, Anupama Hegde
Background: Insulin resistance (IR) is the major underlying mechanism responsible for metabolic syndrome and HOMA-IR2 is a validated marker of IR. Fasting lipid profile, including triglyceride (TG) and high-density lipoprotein (HDL) cholesterol routinely feature in the outpatient investigation list. Utility of TG/HDL ratio as a surrogate marker for IR was thus studied in healthy young males. Materials and Methods: This cross-sectional study involved 71 young males aged 18–35 years who came for a routine health check in a fasting state. Height, weight, waist circumference were recorded. Fasting plasma glucose (FPG) and lipid profile reports were collected from the laboratory database. Fasting insulin (FI) was estimated by enzyme-linked immunosorbent assay. Body mass index (kg/m2), TG/HDL, TC/HDL, and HOMA-IR2 were calculated. Results: Mean TG/HDL ratio was 3.73 ± 2.03 and HOMA IR2 was above the standard cut off of ≥2.5 units. Subjects were further divided into two groups based on FPG values. TG, low-density lipoprotein, total cholesterol, TG/HDL, TC/HDL, FI and HOMA-IR2 were found to be higher in the pre-diabetes with impaired fasting glycemic subjects. Overall, a statistically significant positive correlation was seen (P = 0.01, r = 0.284) between TG/HDL and HOMA-IR2. Conclusion: TG/HDL ratio was significantly associated with IR and it could be used as an indicator of IR especially in prediabetic subjects having impaired fasting glucose.
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Lipoprotein(a) as a risk factor for atherosclerotic peripheral arterial occlusive disease p. 218
Bhavika Ashok Kothari, Kallale Radhakrishnaiyengar Bhagavan, Lancelot Lobo, Nawin Kumar, Abhijit Sudhakar Shetty, Kalikivayi Babu Naresh
Background and Aim: Peripheral arterial occlusive disease (PAOD) commonly results from progressive narrowing of arteries in the lower extremities due to atherosclerosis. The objective of this study was to measure plasma levels of Lipoprotein (a) (Lp[a]) in patients with and without clinical evidence of PAOD and find an association (risk ratio) between Lp(a) and PAOD. Materials and Methods: This study was conducted in the Department of General Surgery at Justice K. S. Hegde Charitable Hospital, Mangalore. The age and sex of the patients, clinical symptoms were noted. The study included a total of 100 patients further divided into two groups: Fifty symptomatic patients with clinical evidence and 50 age and sex-matched asymptomatic patients without clinical evidence of PAOD. History of hypertension, diabetes mellitus, and ischemic heart disease were recorded. The diagnosis basically was made by clinical symptoms and signs. Arterial Doppler/computed tomography angiogram was done only if symptoms or signs of PAOD were present. Two ml of overnight fasting blood sample was collected, serum separated, and was analyzed for Lp(a) by immune turbidometry method. Results: In patients with PAOD, Lp(a) value was 90.06 ± 23.4 mg/dl, whereas among patients without PAOD, Lp(a) values was 48.02 ± 24.1 mg/dl and was statistically significant (P < 0.001). Patients with elevated Lp(a) levels were found to have 13.50 times higher risk of developing PAOD as compared to patients with normal Lp(a) levels. As per the ROC curve analysis, with area under the curve of 0.895 th cutoff value was considered to be 69.8 mg/dl with sensitivity of 88% and specificity of 76%. Conclusion: Males are at a higher risk of developing PAOD as compared to females. Patients within the age group of 51–60 years are more prone to develop PAOD as per this study. From the study results, it was found that there is a high association of patients with PAOD and elevated Lp(a) as compared to other risk factors.
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Comparison of equations for the calculation of low-density lipoprotein cholesterol in thai population p. 224
Lakkana Rerksuppaphol, Sanguansak Rerksuppaphol
Background: Low-density lipoprotein cholesterol (LDL-C) has been established as a major risk factor for cardiovascular diseases. Various equations have been proposed for LDL-C calculation; however, the accuracy of these equations varies among different ethnicities. This study aimed to assess the accuracy and concordance of LDL-C equations for dyslipidemia classifications in Thai adults. Materials and Methods: The lipid profiles of 1091 healthy Thai adults were measured using a homogenous enzymatic assay. The estimated LDL-C equations by Friedewald, Ahmadi, Anandaraja, Chen, Cordova, Densethakul, Hattori, Martin, Puavillai, Sampson, and Vujovic were compared to directly measured LDL-C using Pearson's correlation test. Cohen's kappa statistic was also used to test the concordance of the LDL-C equations with directly measured LDL-C levels, according to the standard guidelines for blood cholesterol management. Results: The LDL-C values calculated by Friedewald, Sampson, and Chen equations showed a high degree of correlation and values close to directly measured LDL-C levels with mean differences ranging from − 0.04 to 0.07 mmol/L. All these three equations had a high degree of concordances with directly measured LDL-C levels for classifying the degree of dyslipidemia. Conclusion: Friedewald, Sampson, and Chen equations showed better estimations of LDL-C levels and had higher accuracy in classifying the degree of LDL-C strata than other equations in the Thai population.
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Effects of muscle-specific exercises compared to existing interventions on insulin resistance among prediabetes population of South India p. 230
K Mohsina Hyder, Jithin Mohan, Visakh Varma, Ponnusankar Sivasankaran, D Raja
Background: India is among the top three countries with diabetes and prediabetes, but interventional studies on prediabetes are less compared to other developed countries. Research design and Methods: This prospective open-label randomized interventional study was conducted among newly diagnosed prediabetes in selected districts of Kerala and Tamil Nadu in South India. Participants were randomized to six treatment groups: Group 1 – walking exercise, Group 2 – muscle-specific exercise (ME), Group 3 – metformin intervention, Group 4 – metformin with muscle-specific exercise, Group 5 – antioxidant intervention, and Group 6 – antioxidants with muscle-specific exercise. Drug intervention was for 12 weeks, and the study parameters of the subjects were measured at predefined intervals. The main outcome measures were homeostasis model assessment (HOMA), glycated hemoglobin (HbA1c), fasting blood sugar (FBS), body mass index (BMI), and waist-to-hip ratio. Results: ME intervention in prediabetes significantly reduced BMI, FBS, HbA1c, and HOMA levels (P < 0.05) during the study period. There was also a significant reduction in waist-to-hip ratio among participants taking low-dose metformin along with muscle-specific exercises. Environmental mobility barriers such as weather, traffic, pollution, social support, and even female gender created obstacles in the walking group that led to nonadherence and no significant results in the walking group compared to other groups. Conclusions: Results showed that muscle-specific indoor exercises can be an effective strategy in early management of insulin resistance with better exercise adherence compared to existing interventions. The Implementation of Prediabetes Education Program increased awareness and self-management skills among the prediabetes population.
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Albumin and urine albumin–Creatinine ratio as acute kidney injury predictors in patients undergoing cardiac surgery p. 237
Arul Senghor, K Manohar, VM Vinodhini, Pragati Kapoor
Context: Postoperative acute kidney injury (AKI) is associated with increased morbidity and mortality in patients undergoing cardiac surgery. Aim: The aim of the present study is to compare preoperative and postoperative serum albumin levels, urine albumin–creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR) in patients undergoing cardiac surgery as a predictor of AKI. Settings and Design: The prospective study was conducted at cardiothoracic unit in the individuals of age 40–70 years admitted for coronary artery bypass grafting. Materials and Methods: The study participants admitted for cardiac surgery with normal serum creatinine value of 0.3–1.3 mg/dl were included. Preoperative and postoperatively (days 1 and 3 after cardiac surgery) parameters such as serum albumin, creatinine, and UACR were analyzed. Baseline serum creatinine >1.6 mg/dl was excluded. eGFR was calculated with Cockcroft's formula and categorized as Group A with eGFR <60 ml/min and Group B with eGFR ≥60 ml/min. Results: Mean UACR compared to baseline was found to be increased progressively on day 1 and day 3 postoperative period after cardiac surgery. Compared with baseline data, albumin levels were found to be decreased during postoperative phase. eGFR reflected the risk of kidney damage as it gets decreased by 15% on day 1 after cardiac surgery. Receiver operating characteristic curve analysis of albumin and UACR revealed sensitivity and specificity that predicts lowered eGFR. Conclusion: Decreased serum albumin and increased UACR after cardiac surgery reflected with lowered eGFR indicate the renal injury after cardiac surgery. Serum hypoalbuminemia and UACR are predictors of AKI in the postoperative phase.
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Isolation, identification, and cytotoxic study of secondary metabolites from Pyxine Coccifera lichen p. 242
RS Rajesh, ML Lal Prasanth
Background: Lichens are renowned organisms with slow growth rate and are competent to extreme habitats with their bioactive secondary metabolites getting enormous attention owing to their dominant contribution in therapeutics. The present work focuses on the ethanolic extraction of a novel secondary metabolite, 5, 7-dihydroxy-3-(1-oxo-1H-inden-7-yl)-4H-chromen-4-one from Pyxine coccifera lichen. Materials and Methods: The secondary metabolite is isolated using column chromatographic technique. A comprehensive phytochemical analysis of the extract is carried out using various characterization techniques. Results: Using ultraviolet, Fourier transform infrared, Thin-layer chromatography High-performance liquid chromatography, nuclear magnetic resonance, and Liquid chromatography-Mass spectrometry, a detailed phytochemical study of P. coccifera ethanolic extract was performed. The results led to the identification and characterization of 5,7-dihydroxy-3-(1-oxo-1H-inden-7-yl)-4H-chromen-4-one based on their precise molecular masses and molecular formula. After dose-dependent treatment with lichen ethanol extract, cell viability analysis measured after 48 h revealed that the morphology of A549 human lung cancer cells had changed. In comparison to monitor cell viability, P. coccifera ethanolic extract (17.50 μg) significantly reduced the spread of A549 human lung cancer cells. Conclusions: The isolated bioactive secondary metabolite has excellent antiproliferative activity against A-549 lung cancer cells.
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Comparative study of malformed atresia ani et recti with or without customized stent in new born calf p. 249
Dayamon D Mathew, Rahul Kumar Udehiya, Naresh Kumar Singh
Introduction: Atresia ani is a congenital condition commonly seen in young animals such as calves, lambs, and kids. Anatomically, atresia ani has been classified into four types, namely, I, II, III, and IV (Vianna and Tobias, 2005). Type I atresia ani is defined as a congenital stenosis of a patent anus. Type II has a persistent complete anal membrane alone or a combination of an anal membrane with the rectum ending as a blind pouch cranial to the membrane. Type III has an imperforate anus with rectum terminating further cranially. Type IV has a normal ending of the terminal rectum and anus, while the cranial rectum terminates as a blind pouch within the pelvis. Aim of the Study: The aim of the study was to compare the use of customized stent-based correction over the routine pattern followed for the correction of atresia ani et recti. Materials and Methods: Two 3 days old calves with atresia ani et recti were subjects for the study. Both cases were surgically corrected by routine standard surgical technique. Furthermore, in second case, a customized stent was used to prevent stricture of anoplasty. Results: Customized stent used here was successful in preventing the anoplasty stricture as well as this prevented soiling the suture site with feces, which is very common after anoplasty procedure. Conclusion: This case report suggests that use of a sterile syringe, which can be customized, may be used as a stent to prevent stricture of anoplasty as well as reduce wound contamination, thus providing better and faster wound healing and reduces the postoperative complications.
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Laparoscopic management of adult ileoileal intussusception due to an inflammatory fibroid polyp: A case report with review of literature p. 252
M Vinoth, Abhijit S Joshi
Intussusception is a rare phenomenon in adults and usually presents with bowel obstruction. Unlike pediatric intussusception, adult intussusception (AI) is seldom idiopathic and frequently associated with secondary causes such as benign and malignant tumors. AI accounts for 5% of all cases of intussusception and almost 1%–5% of all cases of bowel obstruction. We hereby present the rare case of a 42-year-old female patient with ileoileal intussusception caused by an inflammatory myofibroblastic polyp. We also delve into a review of literature on AIs, touching different common and uncommon types as well as their diagnostic modalities and therapeutic options.
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An interesting case of unilateral multiple impacted unerupted teeth in a young adolescent child: A case report and discussion p. 256
Aman Deep, Seema Thakur, Cheranjeevi Jayam
Impaction of teeth is a relatively common manifestation that comes across a clinician, however, multiple impacted unerupted teeth are rarely seen and are manifested due to several genetic, systemic, and local factors. In this case report, A 14-year-old male patient presented with unilateral multiple impacted unerupted primary and permanent teeth affecting the left side of the face and also delayed eruption of teeth on the opposite side. The history and relevant clinical findings depicted a picture toward primary failure of eruption (PFE) as provisional diagnosis. This paper also discusses the clinical presentation of the case and various treatment options that can be employed for the management of such a case. The rarity of this case report lies in the fact that although PFE is seen with a common picture of bilateral involvement based on the clinical and radiographic presentation, this case report presented with unilateral involvement of the dentition, a less commonly described variant in the literature.
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Using biodentine for non-surgical endodontic re-treatment of maxillary central incisor associated with severe external apical root: A case report with 2-years follow-up p. 260
Paras Mull Gehlot, Brinda Murali, Ballagere Mariswamy Annapoorna, Krishna L Prasada
A patient reported with pain and sinus opening in relation to a previously root canal treated maxillary central incisor. Intraoral radiograph revealed periapical radiolucency with shortening of root indicating external apical inflammatory root resorption associated with failed endodontic treatment. Nonsurgical re-treatment was started and intracanal calcium hydroxide (CaOH) was placed for four weeks. The tooth was obturated with Biodentine. At 6, 12, and 24 months follow-up, the patient was asymptomatic and radiograph revealed satisfactory healing. Inflammatory apical root resorption due to failed root canal treatment could compromise the root length and prognosis. Early arrest of such resorption is indicated by nonsurgical re-treatment using CaOH for root canal disinfection and obturating with bioactive material such as Biodentine, which results in the successful arrest of resorption and periapical healing.
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Presurgical nasoalveolar molding therapy in cleft lip palate infant: A successful case report p. 263
Vinod Kumar, MK Shakir, Rohith R Koppalkar, Anisha Nanda, B Karthika, Aleena Babu, Khandelwal Ankita Pravin
Nasoalveolar molding (NAM) is a recent infant orthopedic appliance constructed in cleft lip and palate patients below 3–4 months of age because the moldability of primary cartilage is very high due to high estrogen content in infants below 4 months of age. We started NAM therapy in this case at 3 weeks of age and continued till 4 months of age, the cleft lip gap decreased from 19 mm to 9 mm and palate (alveolar) gap reduced from 9 mm to 3 mm, there was also improvement in nasal anatomy. This is an important case report in which we have successfully completed NAM therapy and also followed the case after lip surgery for 6 months which resulted in better surgical outcome in terms of function and esthetics. In conclusion, we suggest that presurgical NAM improves esthetics, decreases cleft deformities, and prepares the patients for less surgical procedures with better results.
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A rare occurrence of calcifying epithelial odontogenic tumor in a young female p. 268
AH Praveen, R Thriveni, Dipanwita Chakraborty, Malashri Ghatke, Miriyala Satya Shree Vibha
Calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic tumor which can occur extraosseous or intraosseous. The etiopathogenesis of CEOT is not known. It has a propensity toward mandibular molar ramus region and has no sex predilection. The treatment of choice for CEOT ranges from either enucleation, curettage to enucleation, marginal/segmental resection, and radical and extensive resection (hemimandibulectomy) or hemimaxillectomy. This case report describes an incidence and clinical management of CEOT in a young female patient.
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