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  Most popular articles (Since February 12, 2014)

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Oral manifestations of tuberculosis
Shekhar Kapoor, Sumir Gandhi, Nitasha Gandhi, Inderjot Singh
January-April 2014, 1(1):11-14
Tuberculosis (TB) is still among the most life-threatening infectious diseases, resulting in high mortality in adults. A significant proportion of patients (15-25%) exist in whom the active TB infection is manifested in an extrapulmonary site. Healthcare workers, including dentists, are at the frontline and can make an important contribution to the control of this infectious epidemic. Oral TB has been considered to account for 0.1-5% of all TB infections. Nowadays, oral manifestations of TB are re-appearing alongside many forgotten extrapulmonary infections as a consequence of the outbreak and emergence of drug-resistant TB and of the emergence of acquired immune-deficiency syndrome.
  6,237 830 1
Study of histopathological patterns of endometrium in abnormal uterine bleeding
K Sajitha, Shetty K Padma, K Jayaprakash Shetty, HL KishanPrasad, Harish S Permi, Panna Hegde
April-June 2014, 1(2):76-81
Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint associated with considerable morbidity and significantly affects the patient's family, personal and social life. The aim of the study was to analyze the histomorphological patterns of endometrium in patients presenting with AUB and also to determine the incidence of AUB in various age groups. Materials and Methods: This is a prospective study, conducted in the Department of Pathology, in a tertiary care teaching hospital, Mangalore from October 2011 till date. All cases of AUB with a probable endometrial cause were included in the study. Data was entered in Microsoft Excel and managed in Statistical Package for the Social Sciences (SPSS) version 16. Analysis was done in the form of percentages and proportions and represented as tables where necessary. Results: A total of 156 cases were analyzed. Patients' age ranged from 23-78 years. AUB was most prevalent in the perimenopausal age group. The most common presenting complaint was menorrhagia (47%). Endometrial hyperplasia was the most common histopathological finding and was seen in 25% patients, followed by secretory endometrium in 16.7% patients, and proliferative phase pattern and disordered proliferative endometrium were seen in 12.2% patients each. Malignancy was detected in 6.4% of cases and endometrial carcinoma was the most common lesion (4.5%). Conclusions: Histopathological evaluation of endometrial samples is especially indicated in women over the age of 35 years to rule out malignancy and preneoplasia. Among the patients with no organic pathology, normal physiological patterns with proliferative, secretory, and menstrual changes were observed. The most common endometrial pathology in this series was endometrial hyperplasia.
  5,382 624 -
Psychometric properties of a questionnaire assessing nursing professionals' knowledge regarding etiology and prevention of viral hepatitis B and C
Anita Thakur, Deepak Sharma
April-June 2014, 1(2):87-90
Background: Viral hepatitis B and C are a global public health problem. For better targeting their detection and prevention, nursing professionals' should have adequate knowledge and skills. Aims and Objectives: This study aimed at developing a "viral hepatitis questionnaire" and then validating it among nursing professionals' working in a Medical College of North India. Materials and Methods: A fifteen-item questionnaire was developed by the principal investigator. This was based on a systematic search in database namely "PubMed" "IndMed" "Directory of Open Access journals" and "Google scholar". It was then administered to 318 nursing professionals'. The psychometric properties of the questionnaire were assessed in terms of construct validity and reliability. Results: The average age of the study subjects was 23.4 years (SD = 17.2, range = 18 years-54 years). Sampling adequacy as measured by Kaiser-Meyer-Olkin (KMO) test was 0.82. This indicated relevance of the factorial model. Varimax rotation revealed that all items had achieved the required loading of 0.3. The internal consistency ranged from 0.81 to 0.87. The intra class correlation coefficient ranged from 0.67 to 0.71. Conclusion: " Viral hepatitis questionnaire" (VHQ) appears to be a reliable and valid measure of assessing nursing professionals' knowledge about viral hepatitis B and C. Its periodic use can serve the purpose of assessing nursing professionals' training needs. It is further recommended that it should be tested among nursing staff in different healthcare facilities of India, in order to assess its wider performance.
  4,929 134 -
Modifications in the Revised National Tuberculosis Control Program to achieve universal access to tuberculosis care
Saurabh Ram Bihari Lal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
January-April 2014, 1(1):45-47
Global Tuberculosis Report - 2012, released by the World Health Organization (WHO) has revealed that in the year 2011 alone, 11.7 million new cases of tuberculosis (TB) have been reported worldwide, of which India contributed to almost one-quarter of the cases. Considering the global distribution, magnitude of the problem, serious impact on the quality of life, and high mortality rates; TB in today's world is the biggest public health disease of an infectious nature. Revised National Tuberculosis Control Program (RNTCP) has been geographically scaled-up and updated on multiple fronts based on the epidemiology of disease, infield practical experience, WHO's recommendations, and the successful implementation of different strategies in high burden countries. Refinement in the program has been observed in different fields such as diagnostics, treatment, involvement of medical college and private sector, along with some innovative measures. To conclude, strengthening of the RNTCP program has been planned in a comprehensive manner and due attention has been given to encourage and actively involve all the stakeholders so that global vision to achieve universal access to TB care can be accomplished.
  3,393 584 -
Neonatal morbidity and mortality of sick newborns admitted in a teaching hospital of Uttarakhand
Ritu Rakholia, Vineeta Rawat, Mehar Bano, Gurpreet Singh
October-December 2014, 1(4):228-234
Context: India accounts for 27.3% of total neonatal deaths in the world. This rate is highest in poor and marginalized areas like hilly regions of Uttarakhand that lack medical facilities. The newborns referred from here and admitted as outborn neonates contribute to the high neonatal mortality rate (NMR) of India. Aims : To study the demographic profile and morbidity-mortality pattern of neonates admitted in Sick Neonatal Care Unit (SNCU) and study the difference between inborn and outborn neonates. Study Design: Retrospective study of medical records for 1 year (2013-2014). Subjects and Methods: The age, sex, gestational age, and morbidity and mortality profile of all SNCU admissions in 1 year was determined, and the difference between inborn (those born in Teaching Hospital) and outborn (neonates delivered outside and referred) was calculated. Modifiable risk factors to reduce NMR in Uttarakhand were determined. Statistics: The data were analyzed using appropriate statistical tools in software Statistical Package for the Social Sciences (SPSS)-18. Results : Of the 721 neonates admitted, 63.25% neonates were males, and 53.54% were outborn and 46.46% inborn. Approximately, 60% were low birth weight and 50% preterm. Respiratory distress syndrome (RDS) (21.9%), sepsis (19%), perinatal asphyxia (16.37%), and jaundice (12.9%) were the chief morbidities. The chief causes of mortality were prematurity (25.6%), sepsis (21.6%), perinatal asphyxia (19.5%), and RDS (17.3%) with a statistically higher rate in the outborn in comparison with inborn. Total 20.5% neonates died due to poor outcome of outborn neonates. Conclusion: Huge burden of neonatal death among the outborn is due to preventable causes like asphyxia and infections in Uttarakhand. Health policies must ensure increased access to essential services to target sick neonates born here.
  2,897 504 -
A hospital based study of rickettsial diseases evidenced by Weil Felix test in a tertiary care hospital
Uttam Udayan, Meena Dias, Santosh Machado
July-September 2014, 1(3):150-153
Introduction: Rickettsial infections, one of the re-emerging diseases are increasingly underdiagnosed due to nonspecific symptoms, absence of reliable and affordable diagnostic test and contribute substantially to the acute febrile burden and preventive illness in many populations. A delay in diagnosis and therapy are associated with increased morbidity and mortality. Objectives: To determine and categorize rickettsial disease titers by Weil Felix test, and to know the frequency of rickettsial diseases in febrile patients presenting to a tertiary hospital. Materials and Methods: In a prospective study, a total of 100 samples were tested by Weil Felix test from patients with fever and results were analyzed. Results: Out of 100 samples 64 were positive. Male preponderance was seen. The most common clinical symptom were fever, rash followed by hepatomegaly and splenomegaly. One patient with a high titer of more than 1280 died of encephalitis. Conclusion: In the absence of availability of a good reliable serological or molecular evidence, Weil Felix test can be used in the laboratories mainly due to cost and technical aspects of other reliable tests for diagnosis.
  2,754 192 -
Iodine deficiency disorders: Public health measures to mitigate the global burden
Saurabh Ram Bihari Lal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
April-June 2014, 1(2):119-122
Iodine is an essential micronutrient required for the synthesis of the hormones - thyroxine and triiodothyronine. Iodine insufficiency is prevalent throughout the world, and is rated as one of the most significant public health concern in more than 125 countries. An optimal intake of dietary iodine during pregnancy, lactation and early childhood period is crucial for ensuring proper development of the brain of the fetus/newborn. During the course of implementation of the strategy of universal administration of the iodized salt, a wide gamut of challenges has been identified. In order to combat the same and simultaneously enhance the coverage of universal administration of the iodized salt, many measures have been proposed, namely formulating clear plan with time-based targets; encouraging coordination amongst all stakeholders; strengthening of the existing infrastructure; and increasing consumer awareness and demand for adequately iodized salt. To conclude, iodine has a crucial role in ensuring the normal growth and development of the child. However, to expand the coverage of the universal iodized salt to the vulnerable population, sustained political commitment and transparent monitoring and evaluation mechanism is the need of the hour.
  2,596 337 -
Silent bowel perforation with per anal protrusion of ventriculoperitoneal shunt
Sarvpreet Singh Grewal, Sukhdeep Singh Jhawar, Bharat Gupta, Nandini K Bedi
April-June 2014, 1(2):113-115
Ventriculoperitoneal (VP) shunt used in the treatment for hydrocephalus is associated with several complications. Visceral/bowel perforation is an unusual but serious complication of VP shunt. A silent protrusion of distal end of VP shunt per anus is reported in an 8-month-old male child. Patient underwent right VP shunt at the age of 6 months for congenital hydrocephalous. Patient was afebrile and had no signs of peritonitis or meningitis. Exploratory laparotomy was done where shunt was found to penetrate antimesenteric border of sigmoid colon. Shunt was removed and patient is doing well at 6 months follow-up without revision of VP shunt. Etiopathogenesis and management issues are discussed with relevant review of literature.
  2,536 233 -
A study of stress, anxiety, and depression among postgraduate medical students
Anjali N Shete, KD Garkal
April-June 2015, 2(2):119-123
Introduction: Medical education is highly challenging and often places heavy demands on the mental health of the students. Stress is an external constraint which upsets an individual both mentally and physically. The postgraduate students suffer from higher stress that definitely affects the mental wellbeing of these students. Study Design: It is a cross-sectional, observational study. Objectives: The objective of the present study was to explore the level of stress, anxiety and depression among the postgraduate medical students. The secondary objective was to find out the factors affecting the stress, anxiety and depression level in these students. Materials and Methods: Fifty post graduate medical students of Government Medical College were selected. Depression, anxiety and stress scale 42 questionnaires were given for assessment of stress level. A completed scale was taken for assessment from the students. Result: The mean depression score was 6.26 ± 6.00, the anxiety score was 10.34 ± 3.91 and the mean stress score was 15.30 ± 3.93. The present study showed mild anxiety level and moderate level of stress in postgraduate students. The study showed a difference in stress level when compared for age and gender, but it was not statistically significant. When the stress level was compared for clinical and non-clinical departments; the difference was statistically significant. Conclusion: The present study concluded that a high level of stress is seen in postgraduate medical students. The study further concluded that there are various factors which can affect the level of stress. These factors should be assessed separately for the further study.
  2,425 331 -
Antimicrobial stewardship: Strategies for a global response
Jenny Grunwald, John Zervos, Marcus Zervos, Indira Brar
January-April 2014, 1(1):4-10
The increasing antimicrobial resistance worldwide, combined with dwindling antimicrobial armamentarium, has resulted in a critical threat to the public health and safety of patients. To combat this hazard, antimicrobial stewardship programs (ASPs) have emerged. Antimicrobial stewardship programs prevent or slow the emergence of antimicrobial resistance by coordinated interventions designed to optimize antimicrobial use to achieve the best clinical outcomes and limiting selective pressures that drive the emergence of resistance. This also reduces excessive costs attributable to suboptimal antimicrobial use. Even though an ideal effective ASP should incorporate more than one element simultaneously, it also requires a multidisciplinary team, which should include an infectious diseases physician, a clinical pharmacist with infectious diseases training, infection control professionals, hospital epidemiologist, a clinical microbiologist and an information specialist. However, for antimicrobial stewardship (AMS) programs to be successful, they must address the specific needs of individual institutions, must be built on available resources, the limitations and advantages of each institution, and the available staffing and technological infrastructure.
  2,311 317 -
A rare case of male infertility: Sertoli only syndrome
Babulreddy Hanmayyagari, Mounika Guntaka, Srinagesh
January-March 2015, 2(1):64-67
Sertoli cell-only syndrome (SCOS) is not an uncommon finding in testicular biopsies that are performed in patients with infertility. The salient histopathologic feature of SCOS is the absence of germ cells. Many of these patients have a normal karyotype and normal secondary male sexual characteristics, yet are infertile and azoospermic or severe oligozoospermic. This case report describes a 29-year-old male patient who presented with primary infertility, normal physical characteristics and hormonal profile with SCOS detected on testicular biopsy.
  2,248 164 1
Blood-filled blister in the oral cavity: Angina bullosa hemorrhagica
Naveen Kumar Kansal
April-June 2014, 1(2):130-131
  2,212 138 -
Knowledge regarding palliative care amongst medical and dental postgraduate students of medical university in western Maharashtra, India
Purushottam A Giri, Deepak B Phalke
October-December 2014, 1(4):250-253
Background: Palliative care is a relatively new field of medicine. The goal of palliative care is not to cure, but to provide comfort and maintain the highest possible quality of life for as long as life remains. However, there is a paucity of studies on knowledge among postgraduate students from medical and dental disciplines. Objectives: The present study was conducted to assess the knowledge about palliative care amongst postgraduate students of Medical University in Western Maharashtra. Materials and Methods: A cross-sectional study was conducted amongst a total of 178 postgraduate students which includes 112 medical and 66 dental disciplines of Medical University in Western Maharashtra during the period of June-August 2013. Data was analyzed in the form of percentage and proportions and Chi-square test was applied whenever necessary. Results: In the present study, 42.1% students didn't know the concept of 'autonomy' in palliative care, while 107 (60.1%) of students believed that most preferable route of administration in palliative care for treating chronic cases is oral. Among medical students 41.6% had shown overall good level of knowledge, while only 16.6% of dental students showed overall good level of knowledge. There was a significant difference found in the level of knowledge among the postgraduates between two disciplines. Conclusion: The study revealed the inadequacy in knowledge amongst postgraduate students of both disciplines; however knowledge level of dental was poor as compared to medical students. There is need to introduce palliative care in postgraduate curriculum of all health professional education.
  1,901 433 -
Medical diagnostic laboratories provisioning of services in India
Rahi Jain, Bakul Rao
January-March 2015, 2(1):19-31
Context: Diagnostic services have a very important role to play in medical decision-making, which have an impact on the nation's health status. The understanding of Indian diagnostic services provisioning has certain literature gaps. Aims: This study focused on understanding the functioning of provision of diagnostic services by Indian diagnostic laboratories. Materials and Methods: Exploratory field visits and literature review were used as tools to understand the Indian health system. Results: Indian diagnostic laboratory can be classified into various categories based on the type of services provided and governance. The difference in their financing, resources, quality assurance of services and patient access to services was found in these different laboratories. Conclusions: It was concluded from the study that patient's access to laboratory services is affected by the functioning of laboratories in terms of governance, financing, resources, quality assurance of services and patient services.
  2,120 172 -
Incarcerated right inguinal hernia containing sigmoid colon: A rare case report
Amit Mahajan, Anil Luther
October-December 2014, 1(4):281-282
Incarcerated inguinal hernia is a common diagnosis in patients presenting with a painful and non-reducible groin mass. Although the diagnosis is usually made by physical examination, the content of the hernia sac and the extent of the following operation may vary. The usual finding is a segment of small bowel and less commonly large bowel. However, an unusually large number of pathological processes have been recorded in literature, which also present in this manner. Except in sliding hernia, the sigmoid colon is uncommonly found in an inguinal hernia, especially on the right side. We present an extremely rare case of an incarcerated right inguinal hernia containing the sigmoid colon and review relevant literature.
  2,176 100 -
A comparative study of pulse oximetry with the conventional pulp testing methods to assess vitality in immature and mature permanent maxillary incisors
Shini Susan Samuel, Abi M Thomas, Namita Singh
October-December 2014, 1(4):235-240
Context: Subjective pulp tests are not reliable, particularly in children. It is important for dentists to understand the various pulp testing methods that are available in order to make an accurate diagnosis of the state of dental pulp in children. Aims: To assess pulp vitality and compare the reliability of pulse oximetry with the conventional pulp tests (electric pulp test and cold test) in immature and mature permanent maxillary incisors. Subjects and Methods: Sixty selected children aged 7-18 years with normal permanent maxillary central and lateral incisors were categorized into Group I (mature teeth) and Group II (immature teeth). Thirty endodontically treated permanent maxillary incisors were used as the negative control. Statistical Analysis Used: The sensitivity, specificity, positive predictive value, and negative predictive value were calculated and the results were analyzed. Results: The specificity for the pulse oximetry test, cold test, and electric pulp test in Group I (mature teeth) was 100%. The specificity for the pulse oximetry and cold test in Group II was 100% and 80% for electric pulp test. Conclusions: For an accurate pulpal diagnosis in children, one should not rely on one pulp test alone. In young children, pulse oximetry method was found to be as accurate as cold test but large variations were seen in electric pulp test.
  1,975 268 -
Topical anesthetic versus lidocaine infiltration in arteriovenous fistula cannulation
Anisha George, Pratish George, Deepak Masih, Nina Philip, David Shelly, Jasmin Das, Timothy Rajamanickam
April-June 2014, 1(2):95-98
Background: End stage renal disease (ESRD) patients on maintenance hemodialysis undergo arterio-venous fistula (AVF) cannulation prior to each hemodialysis session for blood access. Prior to cannulation lidocaine infiltration is done, which is often perceived as painful. Eutectic mixture of local anesthetic (EMLA) has been found to significantly reduce pain associated with radial artery cannulation compared with lidocaine infiltration. Aims: To evaluate the efficacy of EMLA compared to infiltration of lidocaine in hemodialysis patients for AVF cannulation. Materials and Methods: A single-centre, crossover study of patients with an AVF on regular maintenance hemodialysis was performed in the dialysis unit of a tertiary care teaching hospital. The site of AVF, number of attempts for AVF cannulation and cannula insertion time were recorded. The patients were asked about the acceptability of application of the anesthetic, delay between anesthetic and cannulation and to score the pain on cannulation. Results: Fifty patients were included in the study. With the visual analog scale, pain score on infiltration was 4.8. Pain score on cannulation after topical application was 2.9 and after infiltration, 2.0. The number of attempts for cannulation and the cannula insertion time were similar. Anesthesia was more stressful in the injectable group rather than the topical group (P < 0.001). Delay between anesthetic and cannulation was unacceptable in the topical group (P < 0.001). Patient compliance was better during infiltration compared to topical (P < 0.005). Mean pain score during infiltration of anesthetic was significantly higher than cannulation pain after either anesthetic, although pain on cannulation was higher in the topical group (P < 0.001). Conclusions: EMLA offers a suitable alternative to lidocaine infiltration for patients using AVF for blood access.
  2,047 182 -
Cellular cannibalism: An insight
Deepti Sharma, George Koshy, Sonal Grover, Shinu Koshy
January-March 2015, 2(1):14-18
The phenomenon of cell cannibalism refers to the engulfment of cells within other cells. It is an unusual phenomenon associated with poor prognosis of high-grade cancers. It has been suggested that cannibalism may represent a sort of "feeding" activity aimed at sustaining survival and progression of malignant tumor cells in an unfavorable microenvironment. There is a paucity of literature relevant to cell in cell phenomenon associated with oral cancer. In this review, an attempt has been made to unveil the intricacies of cellular engulfments.
  1,883 274 -
Evaluation of diagnostic reliability of micronuclei in potentially malignant disorders of oral cavity
Sonal Grover, Mujib BR Ahmed, Neethu Telagi, Anil B Shivappa, KP Nithin
January-April 2014, 1(1):15-20
Context: Micronucleus (MN) has been proved to be an important biomarker of genomic damage. MN scoring in oral exfoliated epithelial cells has been used in the past as a biomarker to identify different preneoplastic conditions much earlier than the manifestations of clinical features. However, no attention has been, until now, given to determine the overall accuracy of MN assay in diagnosing potentially malignant disorders (PMDs). Aim: The present study was being conducted to evaluate the diagnostic accuracy of MN assay in PMDs of oral cavity. Materials and Methods: Cytosmears from 30 controls with healthy mucosa and 45 cases as patients with suspicious lesions, clinically diagnosed as PMDs of the oral cavity were taken and separately stained with Papanicolaou (Pap) stain and haematoxylin and eosin (H and E) stain. MN frequency was evaluated and based on the 50 th percentile of all the MN (%) frequency values obtained for both the groups combined; a cut off value was calculated independently for each stain. Results: The sensitivity and specificity with Pap stain was found to be 84% and 93%, respectively, with diagnostic accuracy of 88%, whereas with H and E stain, sensitivity of 89% and specificity of 100% with diagnostic accuracy of 93% was observed. Conclusion: MN assay in oral exfoliated epithelial cells can be conveniently used as a biomarker for the screening of PMDs of oral cavity.
  1,793 355 1
Role of discharge planning and other determinants in total discharge time at a large tertiary care hospital
Shweta Mehta, Jayesh Nair, Sunil Rao, Kasturi Shukla
January-March 2015, 2(1):46-50
Introduction: Discharge time, a crucial quality indicator, is dependent on several other factors like clearance time and patient-related issues. The present study analyzes these determinants and presents measures to control the discharge time. Materials and Methods: This cross-sectional study was conducted during May-June 2013 at a large multispecialty hospital. During initial 15 days, that is, the pilot study, data was collected across various steps where time was consumed during discharge process and initiatives were taken to increase the number of planned discharges. For the main study, discharges were classified as planned/unplanned and patients as insured and uninsured. Results of pilot study and main study were compared. We computed one-sample t-test on overall discharge time, clearance time, and independent sample t-test on discharge time consumed for types of discharges. All results with P < 0.05 were considered statistically significant. Results: Out of 105 discharges, 75 were included wherein mean discharge time of 177.6 (± 613) min was significantly lower than the mean time of 285.42 (±105.46) min taken for 35 discharges during pilot study (P < 0.01). Mean discharge time of 572 (±1378.4) min for the 14 insured patients was significantly higher (P < 0.0001) than the 61 uninsured patients where discharge time was 88 (±84.7) min. Mean discharge time for planned discharges (n = 18) was 85 (±87.9) min that was significantly lower than unplanned discharges (n = 57) with a mean of 524 (±1446.6) min (P < 0.01). ther patient-related factors like, delay in bill payment, request for discounts further increased the discharge time. Conclusion: Planning the discharges reduced the total time of discharge process substantially. Discharge time was substantially high for insured patients that need to be controlled. Departmental clearance and patient-related factors also impact the discharge time.
  1,810 229 -
Deafness and blindness: A rare presentation of meningeal carcinomatosis
Navneet Kumar, Chanchal Gera, Alok Gupta
January-April 2014, 1(1):54-56
A 60-year-old woman presented with progressive loss of vision and deafness with recurrent simple partial seizures. This patient was treated for carcinoma breast 13 years before this presentation. Magnetic resonance imaging brain and magnetic resonance angiography was normal. Cerebrospinal fluid analysis was inconclusive. Meningeal biopsy revealed metastatic deposits and malignant cells were positive for estrogen, progesterone, and HER2nu receptor. This case has some unique features in the form of involvement of optic and vestibulocochlear nerves together, primary site of malignancy was hidden, and diagnosis was made with meningeal biopsy.
  1,813 115 -
Sheehan's syndrome: A clinical, biochemical, hormonal, radiological, bone mineral density and quality of life assessment
Manish Gutch, Sukriti Kumar, Sanjay Saran, Keshav Kumar Gupta, Syed Mohd Razi, Jaideep Tomar, Kamlendra Verma
April-June 2014, 1(2):82-86
Background: Sheehan's syndrome (SS) or postpartum pituitary necrosis though rare, still remains one of the commonest causes of hypopituitarism in the Indian subcontinent. The clinical presentation is often variable with abrupt or insidiously onset pituitary insufficiency after heavy intrapartum or postpartum hemorrhage. Aims: To study the demographic profile, hormonal profile, as well as the quality of life of patients of SS, and the effect of hormonal replacement therapy on outcome. Materials and Methods: All patients previously diagnosed with Sheehan's syndrome or newly admitted during the study period of 2011-2013 were enrolled in the study after obtaining informed consent. Their clinical, biochemical, hormonal, radiological and bone mineral density (BMD) data were collected. The quality of life (QoL) was assessed using the disease-specific questionnaire both before and after hormone replacement therapy. Result: Twenty three patients were enrolled in the study, the mean age of diagnosis was 43.4 ± 14.2 years; mean diagnostic delay was 13.2 ± 7.4 years. Secondary amenorrhea and lactation failure were the most common clinical presentations. The mean total tetraiodothyronine (T4), peak stimulated cortisol, stimulated growth hormone (GH), and prolactin (PRL) levels were low. The gonadotropins [follicle stimulating hormone (FSH) and luteinizing hormone (LH)] were inappropriately normal in the presence of amenorrhea. Anemia was the most common hematological abnormality seen in 69.5% of patients, while 39.1% of patients had hyponatermia. BMD assessment (n = 23) was suggestive of low bone mass. The QoL improved significantly (P < 0.05) in patients after one year of hormonal replacement therapy. Conclusion: Sheehan's syndrome resulted in multiple pituitary hormone deficiencies in all patients. Anemia, hyponatremia, and low bone mass were frequently seen in patients with Sheehan's syndrome. The QoL improved significantly (P < 0.05) after hormonal replacement therapy.
  1,692 221 -
Tobacco use among teenagers in Ludhiana, Punjab, India: A survey of initiation, prevalence, knowledge, and attitude
Ansu Elizabeth Saji, Ritu Jain, Amandeep Pabla
July-September 2014, 1(3):176-179
Introduction: Tobacco use among school going children is becoming a serious public health issue in developing countries like India. According to the study conducted by S.K. Jindal in 2004, in the northern states of India, prevalence of tobacco use was lowest in Punjab because smoking is strongly against the Sikh tenets. However, a recognizable change in trends has been observed recently. Aim: To determine the prevalence of tobacco use, the age of initiation, factors leading to initiation, and the knowledge about the health hazards caused by tobacco use among adolescents in the city of Ludhiana, Punjab. Materials and Methods: A cross sectional study was conducted among 400 adolescents between the ages of 13 to 19 years in Ludhiana using a self-administered questionnaire. Result: In all, 12.75% of the students were found to be tobacco users. The age of initiation was around 15 years. Majority of the students were initiated into this habit by friends or by immediate family members. In total, 78.64% of the students reported to be aware of the harmful effects of tobacco use. Conclusion: This study demonstrated a relatively high prevalence of tobacco use among adolescents in Ludhiana, Punjab. Peer pressure was the main factor in the initiation of this habit. Strict laws need to be passed and interventions designed to reduce the use of tobacco among adolescents.
  1,638 193 -
Dyke-Davidoff-Masson syndrome: A study of clinicoradiological variability in hemiplegia, hemiatrophy and epilepsy patients
Amita Bhargava, Bharat Bhushan, Gaurav Kasundra, Khichar Shubhakaran, S Pujar Guruprashad, Banakar Basavaraj
July-September 2014, 1(3):187-193
Context: Clinicoradiological variability expansion in Dyke-Davidoff-Masson syndrome (DDMS) or hemiplegia, hemiatrophy and epilepsy (HHE) patients. Aims: To explore clinicoradiological features, associated abnormalities and refractoriness issues to antiepileptic drugs (AED) on such kind of epilepsy syndrome. Settings and Design: Prospective and retrospective observational hospital based cohort study. Materials and Methods: Thirty-two patients of HHE were enrolled and interviewed. They were divided into 4 groups congenital versus acquired and seizure control group (SCG) versus seizure refractory group (SRG). We used Naranjo adverse drug reaction (ADR) probability scale for analyzed phenytoin and other drugs adverse reaction. All patients underwent clinicoradiological examination, electroencephalograms, magnetic resonance imaging for parenchymal and skeletal changes. Statistical Analysis Used: Fisher's exact and Student's t-test applied for P value. Results: A total of 32 patients (21 males, 11 females) out of 1182 epilepsy patients were enrolled with mean age of 26.84 ± 9.71 (range: 8-42) years. Twenty-eight patients presented with DDMS, three Rasmussen encephalitis and two HHE syndromes. Congenital type and seizure refractory groups were common presentation. Left lateralization with holo-hemispheric atrophy, cerebellar atrophy, calvarial thickening with frontal sinus hyperpneumatization were significant (P < 0.05) magnetic resonance imaging (MRI) findings. Epileptiform activity was concordant to lesion. Phenytoin adverse effects were significantly (P < 0.03) associated with HHE patients. Remarkable findings of our study included cerebral hemispheric plus cerebellar atrophy (28.12%), hippocampal sclerosis (16%), dystonia, hemiparkinsonism, mirror movement and Dandy-Walker syndrome (DWS). Conclusions: DDMS/HHE can present protean clinicoradiological manifestation, cerebellar atrophy, hippocampal sclerosis and phenytoin intolerance may be one of them.
  1,683 143 -
Anemia: An approach to evaluation, 2014
Philip Kuriakose
April-June 2015, 2(2):95-99
Anemia is very commonly encountered in general clinical practice among all age groups. The more commonly used way to classify anemia has been to categorize it as being microcytic (mean corpuscular volume [MCV] <80 fL), normocytic (MCV 80-100 fL), or macrocytic (MCV >100 fL), which in turn allows for a more practical way to attempt to come up with a cause for any decrease in hemoglobin. Microcytic anemias are usually due to iron deficiency (in turn, a result of a number of different etiologies ranging from decreased intake, malabsorption, or blood loss), hemoglobinopathies (thalassemic syndromes), and some cases of severe anemia resulting from chronic disease. Normocytic anemia is often a result of anemia of chronic disease, hemolysis, or secondary to bone marrow failure. Macrocytic anemias are frequently caused by deficiencies of folic acid and/or Vitamin B12, exposure to toxic agents like drugs that interfere with DNA metabolism and alcohol, as also bone marrow failure states, such as from myelodysplastic syndrome. A comprehensive history, physical examination, and directed laboratory evaluation will help to identify a specific cause for anemia.
  1,506 301 -