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   2012| July-September  | Volume 1 | Issue 3  
    Online since December 26, 2012

 
 
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ORIGINAL ARTICLES
A study of reduction in breath-holding time in smokers and recovery among ex-smokers in bus depot workers
Bakthavathsalam Sreenivas Sudha, Mysore Shrikanth Sunitha, Santhebatchahalli Mahalingappa Nataraj, Murali Dhar
July-September 2012, 1(3):166-171
DOI:10.4103/2278-344X.105080  
Background: Smoking has deleterious effects on breath-holding time (BHT), which has been used in respiratory physiology as a measure of ventilatory response. Evidences regarding assessment of the reversibility of the impact of smoking on BHT and recovery in ex-smokers are ambiguous. Hence, this study was conducted to quantify the reduction in BHT and to assess the reversibility of the same. Materials and Methods: A cross-sectional study was conducted on 84 bus-depot workers consisting of equal number of smokers, ex-smokers, and non-smokers. Breath-holding time was recorded using the mouth piece attached to the mercury manometer where the subjects were advised to blow through the mouth piece after full inspiration as long as possible till the breaking point following standard methods and precautions. Comparisons among 3 groups were performed employing one-way ANOVA and post-hoc tests. The significance of difference in BHT between the 2 categories of frequency and duration of smoking was tested using Student's t-test for independent samples. Results: BHT was found to be significantly reduced among smokers compared to non-smokers. Almost complete recovery of BHT was observed in ex-smokers. There was deterioration in BHT with increase in BMI, and a statistically significant negative correlation was observed when BHT was correlated with age, especially in smokers. Conclusion: Present study has demonstrated considerable reduction of BHT in smokers and indications of recovery in ex-smokers. Further detailed study with larger sample size, stricter definition of ex-smokers, and considering physical activity is recommended.
  30,590 621 2
SHORT COMMUNICATIONS
Drug-resistant Gram-negative bacilli in urinary tract infection: A need for strict antibiotic prescription policy
Vinita Dogra, Abha Sharma, Bibhavati Mishra, Archana Thakur, Poonam S Loomba
July-September 2012, 1(3):204-206
DOI:10.4103/2278-344X.105090  
Introduction: The etiology of urinary tract infections (UTIs) and the antibiotic resistance of uropathogens have been changing over the past years. This retrospective study was conducted to survey the resistance pattern of Gram-negative uropathogens to first-line agents for UTIs; this would be helpful for the clinicians to facilitate the empiric treatment and management of patients with UTI and maybe useful for the formulation of guidelines of antibiotic policies. Materials and Methods: Isolated uropathogens were tested against ampicillin-sulbactam, amikacin, ceftriaxone, cefotaxime, cefoperazone, gentamicin, norfloxacin, ofloxacin, piperacillin-tazobactam, and imipenem. Result: A total of 2,146 urine samples were cultured, of which 448 samples were positive for Gram-negative bacilli. The most common Gram-negative isolate was Esherichia coli (52%) followed by Klebsiella pneumoniae (17.6%) and Pseudomonas aeruginosa (12.9%). E. coli was found to be most resistant to ampicillin-sulbactam (90.1%), followed by norfloxacin (76.3%), and most sensitive to imipenem. P. aeruginosa was least resistant to amikacin (27.5%). Overall resistance to imipenem is less than 20% among the Gram-negative uropathogens except Acinetobacter spp. and P. aeruginosa. Conclusion: Ofloxacin and amikacin are recommended as the drugs of choice for the empirical treatment of UTI, whereas specific treatment should be based on the etiological agent isolated in the urine culture. There is a strict need for developing specific guidelines for antibiotic prescriptions for UTI in India.
  16,476 623 4
CASE REPORTS
Non-rigid connector in fixed partial dentures with pier abutment: An enigma simplified
Prince Kumar, Vishal Singh, Roshni Goel, Harkanwal P Singh
July-September 2012, 1(3):190-193
DOI:10.4103/2278-344X.105086  
In the fixed partial denture (FPD) prosthesis with rigid connectors, forces of mastication are transmitted to the terminal retainers, which make the middle abutment act as a class I lever fulcrum. This techno-clinical cycle often causes failure of the fixed partial dentures. To overcome this dilemma, a non-rigid connector may be incorporated on the distal aspect of the middle (pier) abutment. The non-rigid connector counterbalances the effects of these forces of leverage. This clinical report presents the use of a non-rigid connector in a long-span, five-unit FPD, replacing two missing teeth with an intermediate pier abutment.
  15,337 1,350 1
ORIGINAL ARTICLES
Effect of graded early mobilization versus routine physiotherapy on the length of intensive care unit stay in mechanically ventilated patients: A randomized controlled study
Priyakshi Bezbaruah, Narasimman Swaminathan, Cherishma D'silva, Shabari Kidyoor
July-September 2012, 1(3):172-177
DOI:10.4103/2278-344X.105081  
Background: Early mobilization is an important component of physiotherapy used to prevent and decrease pulmonary and immobilization complications, which are the major goals of physiotherapy in the intensive care unit (ICU). Prolonged bed rest and hospitalization leads to deconditioning and weakness which can further increase the length of the ICU stay. This study was conducted to find an answer to whether early mobilization is as effective as or better than routine physiotherapy in reducing the length of ICU stay in mechanically ventilated patients. Study Design: Randomized controlled study. Study Setting: Medical ICU, Father Muller Medical College Hospital. Mangalore, Karnataka, India. Aim: To detect the effectiveness of graded early mobilization and routine physiotherapy and to compare these techniques with respect to the length of ICU stay in mechanically ventilated patients. Materials and Methods: Fifteen subjects of both gender who were on mechanical ventilators fulfilling the inclusion criteria were randomly assigned to two groups, group 1 (graded early mobilization, n = 8) and Group 2 (routine physiotherapy, n = 7) by using the randomization plan from the website www.randomization.com. All the vitals of the subjects were noted as they were made to perform particular maneuvers depending on the group they belonged to. Participants recruited into the early mobilization group were mobilized as soon as their vitals were stable and were able to participate in the therapy. The patients who underwent routine physiotherapy were mobilized once they were extubated. At the time of discharge from the ICU, days of weaning, days first out of bed, and length of ICU stay were noted. Results: A significant difference was observed between early mobilization and routine physiotherapy groups with respect to the length of ICU stay. Conclusion: Early mobilization showed better outcome compared to routine physiotherapy in reducing the length of ICU stay in mechanically ventilated patients. The results of this study cannot be generalized due to the small number of subjects.
  7,512 1,061 6
CASE REPORTS
Post-burn facial contractures in pediatric patients: Challenging aspects of difficult airway management
Sukhminder Jit Singh Bajwa, Jasbir Kaur, Amarjit Singh, Gurpratap Singh
July-September 2012, 1(3):186-189
DOI:10.4103/2278-344X.105085  
Pediatric burn injuries are the most challenging to handle especially when they involve the face as the airway compromise invariably occurs due to edema and inflammation of the soft tissues of pharynx and larynx. The healing of the facial burns causes development of contractures and deformities after survival from the initial insults. Such patients when presented for surgery of the affected area or for that matter any surgery under general anesthesia, poses unique challenges to the attending anesthesiologists. Not only there are technical difficulties, but the socio-behavioral aspects related to pediatric age group and the various side-effects of anesthetic drugs are the main concerns for the anesthesiologist during the entire operative intervention. We are presenting a case of an infant who was brought to our institute by his parents for the cosmetic correction of the contractures and deformities of the lower face and the neck and in whom we faced extensive airway challenges because of the nature of the surgery.
  5,082 396 2
Melorheostosis in young adult: A diagnostic dilemma
Tushar N Rathod, Ajay Chandanwale, Shital Chavan, Shewta Rathod, Pramod M Patil
July-September 2012, 1(3):183-185
DOI:10.4103/2278-344X.105084  
Melorheostosis is one of noninheritable developmental mesenchymal dysplastic condition, included in sclerosing bone disorders. It was described by Léri and Joanny as "hyperostose en coulee" i.e. hyperostosis resembling flowing candle wax. It follows a sclerotomal pattern and is usually monomelic though single bone or multiple bone of same limb may be affected. This is rare case report of middle aged man who presented with intermittent episodes of pain and swelling around ankle after a episode of trauma with radiological features suggestive of sclerotic lesions involving tibia, tarsals and metatarsals, suggesting activation of quiescent lesions symptomatically after trauma. Thus this article highlights possibility of keeping diagnosis of Melorheostosis in mind while dealing with such type of case and avoid unnecessary intervention to address radiological lesion.
  4,795 302 3
ORIGINAL ARTICLES
Comparative study of safety and efficacy of electrocautery blade with cold scalpel blade for skin opening during fixation of fracture of forearm bone with plate and screws
KT Madhukar, MT Ganesh
July-September 2012, 1(3):153-157
DOI:10.4103/2278-344X.105065  
Introduction: The art of performing surgeries have improved in recent years with the development of various electrosurgical devices assisting surgeons in performing safer surgeries with better outcomes. Skin incision has traditionally been made with a standard scalpel blade with good primary healing end results of the wound. The electrocautery has been used safely in performing deeper dissections. Use of electrocautery in skin incision has been discouraged in the past for the fear of cutaneous scarring, wound dehiscence, and infections particularly in orthopedic surgeries using internal implants. A review of the literature shows not many studies have been conducted to evaluate the safety and efficacy of electrocautery in skin incisions during orthopedic surgeries using internal implants. Aim: A prospective study was conducted in a tertiary care hospital with the aim to determine whether an electrocautery blade can be used safely for skin incisions. Materials and Methods: Sixty-two patients with single-bone fracture of the forearm undergoing open reduction and internal fixation received one-half of the incision with a standard scalpel blade and another half with electrocautery in pure cutting mode randomly. Analysis: Wounds were compared on operating day for any physical changes and on days 3, 5, and 12, and again on 3 rd and 6 weeks follow-up to know any difference in skin healing between the incised wounds of the two halves. Results: No evidence of any difference in healing of the two halves of skin incision was noted. There was also no increased risk of wound scarring, dehiscence, or infection with electrocautery incision when compared with standard scalpel incision. The time taken for skin incision with electrocautery was significantly less when compared with cold scalpel incision. Conclusion: We propose that electrocautery can be safely used for performing skin incision, with comparable results to that of a standard scalpel skin incision.
  4,617 400 1
SHORT COMMUNICATIONS
The serum protein carbonyl content level in relation to exercise stress test
Titiporn Mekrungruangwong, Porrnthanate Seenak, Saowanee Luangaram, Tomon Thongsri, Sarawut Kumphune
July-September 2012, 1(3):200-203
DOI:10.4103/2278-344X.105089  
Background: Protein carbonyl (P) is oxidatively-modified protein with diagnostic potential for acute myocardial infarction. However, many findings indicated the elevation of serum PC content level related to exercise, which could cause false positive results and limiting the specificity for acute coronary syndrome diagnosis. This study aims to evaluate the level of serum protein carbonyl content in healthy volunteers subjected to exercise stress test (EST). Materials and Methods: Serum from healthy volunteers was collected 5-10 min before performing EST and 1 hour after the EST was achieved. The serum was collected, and the serum PC content level was determined by spectrophotometric DNPH assay. Results: The serum PC content level after exercise stress test was significantly higher than that of before performing EST (0.373 ± 0.05 nM/mg vs. 0.275 ± 0.02 nM/mg, P < 0.0001). The results demonstrated that in both male and female, serum PC content level after EST was significantly higher than that of before performing EST (0.29 ± 0.03 nM/mg vs. 0.36 ± 0.05 nM/mg P < 0.0001 in male, 0.27 ± 0.02 nM/mg vs. 0.38 ± 0.06 nM/mg P < 0.0001 in female, respectively). Conclusions: This study demonstrated that exercise stress test could result in non-specificity and false positive increasing in serum PC content level in healthy subjects, which may cause misinterpretation when using PC as cardiac marker, especially in patients, who underwent exercise stress test or patients who performing heavy physical activities.
  4,093 469 7
ORIGINAL ARTICLES
Factors associated with preterm delivery in women admitted to hospitals in Khorramabad: A case control study
Katayoun Bakhteyar, Nahid Lorzadeh, Yadoolah Pournia, Mehdi Birjandi, Farzad Ebrahimzadeh, Aziz Kamran
July-September 2012, 1(3):147-152
DOI:10.4103/2278-344X.105064  
Background: Preterm birth is the leading cause of neonatal mortality and a major public health concern. This study aimed to determine factors influencing preterm labor in women referring to hospitals in Khorramabad in 2009-10. Materials and Methods: This case-control study was conducted on 524 mothers (262 subjects in each group) referring to hospitals in Khorramabad (west of Iran) in 2009-10, selected through consecutive sampling. A questionnaire was completed through interviews for each newborn after being examined. Collected data, were analyzed by using the logistic regression and odds ratios and a significant level of 5%. The logistic regression model sensitivity in detecting cases of preterm labor was 86%. Results: The frequency of preterm labor in mothers under 20 was 5.83 times higher than that in mothers in the age range of 20-35 (CI=2.99, 11.37, and P < 0.001). The odds ratios for preterm birth were highest for multiple pregnancies and preterm delivery in mothers with a history of obstetric complications as preterm delivery, low birth weight, stillbirth and abortion is seen more than that in other mothers. Conclusion: These findings will be useful for medical staff and public health workers in attempting to identification and management of risk factors and unfavorable social environment and provide early intervention to reduce the risk of preterm delivery.
  4,102 440 3
CASE REPORTS
Occurrence of fourth mandibular molars bilaterally and a supernumerary tooth in premolar region: A rare case
Vinay Kumar Bhardwaj, Sanjeev Vaid, Nishant Negi, Anil Chug, Pravesh Jhingta, Atul Chauhan
July-September 2012, 1(3):197-199
DOI:10.4103/2278-344X.105088  
To present a rare case of fourth molar bilaterally and a supernumerary tooth in #35 region in the mandible. Brief review of the literature; presentation of the clinical data of the patient and images of the case. Supernumerary fourth molars are rare anomalies of the maxillofacial complex that are more common in the maxilla than in the mandible. Panoramic radio graphs of a female patient aged 38 years revealed the presence of two impacted bilateral mandibular fourth molars and unilateral supernumerary tooth. The supernumerary teeth had normal tooth morphology with regard to their crowns and roots and were similar to the existing third molars and premolars.
  4,126 294 -
MEDICAL EDUCATION: REVIEW ARTICLE
Use of objective structured clinical examination and structured clinical instruction module for interprofessional education on cancer: A focused review
Senthil P Kumar, Krishna Prasad
July-September 2012, 1(3):135-141
DOI:10.4103/2278-344X.105062  
American association for cancer education had emphasized the role of structured educational programs for medical students and residents in primary care specialties in order to improve palliative oncology education. Dissatisfaction with the conventional methods of clinical assessment on the part of teachers and students led assessors to search for appropriate alternatives and in 1975, Harden and his colleagues introduced the objective structured clinical examination (OSCE). OSCE was introduced as a standardized tool for objectively assessing clinical competencies−including history-taking, physical examination, communication skills, data interpretation, etc. It consists of a circuit of stations connected in series, with each station devoted to the assessment of a particular competency using pre-determined guidelines or checklists. The Structured Clinical Instruction Module (SCIM) modifies the OSCE for teaching purposes. The objective of this review is to provide a focused update on the status and applicability of SCIM and OSCE in cancer for educational use in palliative care. From the 12 studies which were on OSCE and 6 studies which were on SCIM, it appears that the two competency-based evaluation methodologies used in cancer education namely the OSCE and the SCIM are well validated and reliably used across settings and samples of students, practitioners, and patients. Future studies in Indian palliative care settings are warranted prior to extrapolation of existing evidence.
  3,937 361 -
CASE REPORTS
Disseminated chromoblastomycosis: Diffuse truncal involvement with hematogenous spread
KVT Gopal, TV Ramani, Supriya Panda, PVB Rama Laxmi
July-September 2012, 1(3):194-196
DOI:10.4103/2278-344X.105087  
Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue caused by one of the several species of dematiaceous fungi usually affecting the extremities and spreads by local inoculation and through lymphatics. A 27-year-old male alcoholic presented with a diffuse large polycyclic, indurated, verrucous crusted plaque covering the entire lower back of 6 months duration that gradually extended to involve the right flank and abdomen. Since 2 months, he developed extensive multiple discrete verrucous nodules with a crusted and scaly surface over the face and all extremities. Systemic examination revealed no abnormalities. Serum biochemistry profile and HIV screening revealed no abnormality. Histopathological examination demonstrated pseudoepitheliomatous hyperplasia, granulomatous reaction with foreign body giant cells, and scattered pigmented thick-walled yeast like cells in the dermis suggestive of chromoblastomycosis. Cultures on Sabouraud's dextrose agar grew dark greyish velvety fungal colonies that on microscopic examination revealed acropetal budding with oval-shaped conidia suggestive of Cladophialophora carrionii. We report the first case of chromoblastomycosis from the coastal region of Andhra Pradesh, who was immunosuppressed due to severe alcoholism and presented with extremely rare features of extensive truncal involvement and hematogenous dissemination.
  3,885 281 2
ORIGINAL ARTICLES
A study of an association between tuberculosis and HIV among ICTC attendees at a tertiary care hospital of Shimla, Himachal Pradesh, India
Tripti Chauhan, Ashok K Bhardwaj, Anupam Parashar, Anil K Kanga
July-September 2012, 1(3):142-146
DOI:10.4103/2278-344X.105063  
Background: In India, HIV epidemic and tuberculosis (TB) have posed enormous challenges in the control of TB. Objectives: To determine the proportion of TB in HIV positive and HIV negative patients. Materials and Methods: This hospital based cross-sectional study was conducted in the ICTC of Indira Gandhi Medical College, Shimla from 1 st January 2007 to 31 st August 2007. A sample of 525 consecutive attendees in the age group of 15 to 50/> years were included as study subjects. After counseling, confirmation of HIV status was done according to NACO and diagnosis of TB as per the RNTCP guidelines. Their clinical presentations, PTB and site of EPTB were studied.A pretested questionnaire was used to collect a detailed history followed by a physical examination. Laboratory and radiological investigations were carried out appropriately. Results: Among the 525 attendees, 198 (37.7%) were seropositives and 327 (62.3%) were seronegatives. Of the seropositives more affected were females, 105 (53%) than males, 93 (47%). Wherein among seronegatives, male to female ratio was 2:1. The most common symptoms of PTB among seropositives were cough >3 weeks in 40%, followed by production of purulent sputum in 33.8% and fever >3 weeks in 23% as compared to seronegatives, where the commonly reported symptom was cough >3 weeks in 25.4% (P < 0.00002). EPTB was observed in almost double the proportion, 24.2% of seropositives as compared to seronegatives, 12% (P < 0.0001). However, 17.7% of seropositives as compared to 10.1% of seronegatives were suffering from PTB infection (P < 0.006). Conclusion: TB in HIV patients presentas extra-pulmonary involvement more frequently.
  3,739 357 -
CASE REPORTS
Clear cell renal carcinoma with areas of chromophobe renal cell carcinoma
Rekha Thodavadi Subbanna, Nandini Nandish Manoli
July-September 2012, 1(3):178-180
DOI:10.4103/2278-344X.105082  
The classification of renal cell carcinoma (RCC) is based upon various histological features which aids in determining the treatment and prognosis. We report a unique case of RCC displaying features of predominantly clear cell RCC with areas of chromophobe RCC in an unusual edematous background. The tumor cells from chromophobe RCC were positive for Hales colloidal iron stain. On Immunohistochemistry majority of them were positive for vimentin and CD10, the markers of clear cell RCC with scattered cells positive for cytokeratin 7, marker of chromophobe RCC. It was grade 4 malignant tumor according to Fuhrman nuclear grading.
  3,798 277 -
LETTERS TO EDITOR
Noise pollution in dental office: Are we sheltered?
Prince Kumar, Roshni Goel, Ashish Kumar, Harkanwal P Singh
July-September 2012, 1(3):207-208
DOI:10.4103/2278-344X.105091  
  3,514 495 -
CASE REPORTS
Concurrent malaria and dengue infection
Varun Malhotra
July-September 2012, 1(3):181-182
DOI:10.4103/2278-344X.105083  
This article reports clinical and epidemiological profiles of a case of concurrent malaria and dengue infection. The literature on the subject is briefly reviewed to high-light the significance of the concurrent infection to the clinicians practicing in geographical areas endemic to both infections.
  3,543 351 3
ORIGINAL ARTICLES
Clinical and epidemiological features among hospitalized patients of pandemic influenza A (H1N1) in Saurashtra region, India: A two wave comparison
Rajesh K Chudasama, Umed V Patel, Pramod B Verma, Ravikant R Patel, Priyanka K Patel
July-September 2012, 1(3):158-165
DOI:10.4103/2278-344X.105079  
Objective: To study and compare clinical and epidemiological characteristics of patients who were hospitalized with influenza A (H1N1) infection for two waves in Saurashtra region. Materials and Methods: Total 274 patients admitted during the first wave from September 2009 to March 2010 and 237 during the second wave from June 2010 to February 2011 with 2009 influenza A (H1N1) virus were admitted in different hospitals in Rajkot city. Real-time reverse-transcriptase-polymerase-chain-reaction (RRRT-PCR) testing was used to confirm infection; the clinical and epidemiological features of the disease were closely monitored. Results: The median age of positive cases reported was 27 years in the first wave and 29 years in the second wave, respectively. The median duration of diagnosis of infection was reported five days after onset of illness in both the waves. Majority of patients were reported with cough and fever. Total 160 patients were reported with at least one underlying condition. Hypertension and diabetes mellitus either alone or together was mainly reported as the underlying condition during both season, followed by chronic pulmonary diseases and pregnancy. More number of pregnant women were reported with a range of 5 to 9 months of amenorrhea during first wave (5.5%) compare to second wave (3.0%). Conclusion: We have demonstrated that during two waves, infection-related illness affects both children including infants and adults with survival of 77.2% patients in second wave. Pregnancy was found as a significant (P < 0.05) risk factor for severe disease. Significant number of patients with severe influenza A (H1N1) received antiviral treatment within two days of onset of illness.
  3,347 383 -
LETTERS TO EDITOR
Diagnostic dilemma for both radiologist and pathologist-dilated follicles or small dentigerous cyst
Harkanwal P Singh, Prince Kumar, Ruchika Bansal, Suresh Yadav
July-September 2012, 1(3):210-210
DOI:10.4103/2278-344X.105094  
  2,722 300 -
Shifting trends in oral cancer with the winds of changing time
Harkanwal P Singh, Sandeep K Bains, Tajinder Bansal, Prince Kumar
July-September 2012, 1(3):209-210
DOI:10.4103/2278-344X.105093  
  2,495 245 -
Acinetobacter infection in the Neonatal Intensive Care Unit in a tertiary care hospital in India: Risk factors, susceptibility profiles
Kalidas Rit, Bipasa Chakraborty, Parthasarathi Chakrabarty, Rajdeep Saha
July-September 2012, 1(3):208-209
DOI:10.4103/2278-344X.105092  
  2,453 275 -
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