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   Table of Contents - Current issue
January-April 2017
Volume 44 | Issue 1
Page Nos. 1-60

Online since Monday, March 20, 2017

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Cancer in childhood p. 1
Rajendra B Nerli, Shridhar C Ghagane
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Dentistry in E-world p. 2
Darshana Bennadi, Niharika Reddy Thummala, S Sibyl
Social media is making interactions possible between users and service providers by providing relatively simple, easy to access unbiased platforms for sharing feedback. Social media and the internet offer a wealth of opportunities for dentists to directly connect with their patients and other people in the dental field. These are making inroads in the education of patient as well as professionals, research, peer-reviewed patient care, and oral health-care information. This paper reviews role of internet, social media in dental field with its pros and cons.
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Role of squash smear in intraoperative consultation of central nervous system tumors p. 7
Padmanaban Krishnan Govindaraman, N Arumugam, C Ramasamy, Gowri Prakasam
Introduction: Intraoperative squash smear cytology is an important diagnostic tool; it guides the neurosurgeon during surgical resection and lesion targeting. It also helps the surgeon to monitor and modify the approach at surgery. Inherent soft nature of the central nervous system (CNS) lesions yields good quality material on squash smears because of scant connective tissue. In this study, we have assessed the diagnostic accuracy of squash smear by comparing with histodiagnosis. Materials and Methods: This was a prospective study; we received 75 cases for squash cytology during the study. Complete clinical and radiological findings were recorded. The smears were stained by rapid hematoxylin and eosin method. The cytomorphological features were studied on squash preparation and cytodiagnosis was informed to neurosurgeon peroperatively, and it was compared with tissue sections. Results: Peak incidence of brain tumors was observed in the 31–40 years age group and male to female ratio was 1:1.1. Astrocytomas formed the largest category of tumors. Sixty-eight cases showed complete concordance with final histodiagnosis, with a diagnostic accuracy of 90.67%. Conclusion: Squash smear cytology proved to be a simple, inexpensive, rapid technique for intraoperative consultation of CNS tumors and also aids the neurosurgeon for further proper management.
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Comparison of level of depression among mothers with lower segment cesarean section and vaginal delivery: A cross-sectional study p. 15
Arati Vinay Mahishale, Jahnvi Ashokkumar Bhatt
Background and Objective: Postpartum depression (PPD) is very common among women and is a major public health problem. However, there is a wide range of the prevalence of postnatal depression among women from different countries. Women with lower segment cesarean section (LSCS) or vaginal delivery both undergo depression. However, no studies have compared the level of depression among LSCS and vaginal delivery in Indian as well Western scenario. Hence, the objective of the present study was to compare the level of depression among mothers with LSCS and vaginal delivery. Methodology: A total of 170 females were screened using Edinburgh Postnatal Depression Scale (EPDS) on the 7th day postpartum for PPD, of which 85 females had undergone LSCS and 85 females had undergone vaginal delivery. The EPDS consists of 10 items and each item is rated on a four-point scale, giving maximum scores of 30. Mothers who scored above 13 were likely to be suffering from a depressive illness of varying severity. Results: The results of the present study showed that 8.23% women with vaginal delivery had depression whereas 21.17% LSCS women showed significant depression. Conclusion: PPD was found to be higher among mothers with LSCS as compared to mothers with vaginal delivery.
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Cerebral venous thrombosis in women from Indian subcontinent p. 20
Aralikatte Onkarappa Saroja, Chandrakanth Tapsi, Karkal Ravishankar Naik
Background and Purpose: Cerebral venous thrombosis (CVT) is one of the common causes of stroke in women. The causes in pregnancy include acquired hypercoagulable state and are multifactorial in nonpregnant women. This study was conducted to evaluate clinical profile, risk factors, and outcome of cerebral venous sinus thrombosis in pregnant and nonpregnant women. Methods: Women with radiologically proven CVT admitted between 2001 and 2014 were included in the study. Data regarding demographic features, clinical profile, laboratory parameters, and follow-up at 1, 3, and 6 months were analyzed both prospectively and retrospectively. Results: During the study period, 150 women with CVT were admitted. Among them, 69 were related to pregnancy (antepartum 3 and postpartum 66). Eighty-one women had CVT unrelated to pregnancy. Patients with pregnancy-related CVT were younger (24.55 ± 4.16 years) with shorter duration of symptoms (4.97 ± 5.73 days), compared to nonpregnant women who were older (37.14 ± 12.85 years) with longer symptom duration (11.51 ± 18.96 days). There was no difference in the clinical presentation except for higher incidence of altered sensorium in pregnancy group and higher incidence of partial seizures in nonpregnant group. Pattern of venous sinus involvement and infarction was similar in the two groups. Nonpregnant patients had multiple risk factors, severe anemia being the most common followed by the use of oral contraceptives, hyperhomocysteinemia, protein C/S deficiency, malignancy, and psoriasis. Mortality and long-term outcome were similar. Conclusions: Our study reveals a higher proportion of nonpregnant women with CVT. Clinicoradiological profile and outcome did not differ between pregnant and nonpregnant states.
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'Loose' cigarettes association with intensity of smoking: A secondary data analysis from Global Adult Tobacco Survey, India, 2009-10 p. 26
Mitasha Singh, Vishal Dogra, Ravinder Kumar, Ajay M V Kumar
Context: Raising tax on tobacco products is one of the key tobacco control strategies. Globally, it has led to decrease in overall cigarette consumption but on the other hand contributed to increased sale and purchase of loose cigarettes. These loose cigarettes have many important public health implications. Aim: To assess the association between practice of buying loose cigarettes and intensity of smoking. Materials and Methods: A secondary analysis of Global Adult Tobacco Survey, India 2009–2010 data was performed in May 2014, on adult population age 15 years and above. The key outcome variable was “intensity of smoking” defined as average number of cigarettes smoked per day, whereas the key exposure variable was “practice of purchasing loose cigarettes.” Descriptive statistical analysis was performed using EpiData software (version and STATA version 12.1. Results: Nearly, 57% of current cigarette smokers (approximately 3.46 million) bought loose cigarettes. The proportion of buying loose cigarettes decreased with increasing level of education and wealth index as well as least among government employees. The intensity of smoking was 70% less among loose cigarette buyers than nonbuyers (odds ratio [OR]: 0.29, 95% confidence interval [CI]: 0.24–0.34). It was found to be significantly lower in rural areas (OR: 0.81, 95% CI: 0.68–0.97) and among homemakers and those who had formal schooling. Conclusion: This study showed that loose cigarette buying is associated with decreased in smoking intensity. This may be due to increased taxes leading to increased buying of single cigarettes. These findings, therefore, highlight a need for a comprehensive policy and further studies on loose cigarette selling.
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Cost of initial management of musculoskeletal injuries due to road traffic crashes: A register-based study from North-West India p. 31
Bhanu Awasthi, Sunil Kumar Raina, Lucky Verma, Sandeep Kalia
Background: There is a paucity of information on the actual costs incurred by the family as a result of musculoskeletal injuries due to road traffic crash from our part of India. This study was conducted with the objective to ascertain the costs of initial management of musculoskeletal injuries due to road traffic crashes. Materials and Methods: This prospective study was conducted as a register-based descriptive study in a tertiary care teaching hospital in a rural area (with a predominantly mountainous terrain) of North-West India. All patients with nonfatal musculoskeletal injuries due to road traffic crashes, presenting between 2014 and 2015 and agreeing to participate in the study were included in the study. Results: Of 313 cases, 116 were managed conservatively, whereas in 189 cases, operative intervention was required. In 8 cases, both the modalities of management were required. The average cost of management was Rs. 20,386 in operative group. The average cost in the conservative group was Rs. 3726. Average cost calculated for patients in whom both modality of treatment was required was Rs. 24,000. It was observed that the indirect cost of management was proportionately higher in conservative group. Conclusions: The initial cost of management for patients managed conservatively is less than those managed by operative intervention. Importantly, however, the indirect cost of management is a major contributor to the total cost of management.
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Study of dynamic lung function parameters in normal, overweight, and thin school boys p. 36
Debasish Das, Himel Mondal, Minati Patnaik
Background: In India, childhood undernutrition and obesity both are major health concerns. Lung functions are affected in both thin and obese children. Body mass index (BMI)-for-age is a simple tool suggested by the World Health Organization for categorizing children and adolescents below 19 years. Aim: The aim of the study was to compare dynamic lung function parameters of overweight and thin boys with normal boys. Materials and Methods: One hundred and fifty school boys of age group 12–16 years were included as a convenience sample after screening 234 students. BMI-for-age chart developed by the World Health Organization was used to categorize participants into normal (n = 50), overweight (n = 50), and thinness (n = 50) group. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV3, peak expiratory flow rate (PEFR), and forced expiratory flow (FEF) at the midportion of FVC (FEF25-75) were measured by MEDSPIROR. Unpaired t-test and Pearson correlation (r) were used according to the necessity. Results: Thin boys had lower FVC (P = 0.019), FEV1 (P = 0.048), FEV3 (P = 0.007), PEFR (P = 0.0002), and FEF25-75 (P = 0.003) compared to normal boys. Overweight boys showed significantly increased FVC (P = 0.019), FEV1 (P < 0.0001), and FEV3 (P = 0.0005) compared to normal boys. BMI of thin boys showed positive correlation with FVC (r = 0.49, P = 0.0003), FEV1(r = 0.40, P = 0.003), and FEV3 (r = 0.53, P < 0.0001). Correlation coefficients were not significant for BMI and dynamic lung function test parameters in normal and overweight boys. Conclusions: Thin boys have lower dynamic lung functions than normal boys. Increase in body weight may help in increasing their lung function status.
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Improved level of function in an individual with Carcinoma of the pyriform sinus undergoing radiotherapy: A case report study p. 40
AK Akhil, Varun Naik
A 72-year-old female with a history of cough and difficulty in swallowing was admitted in KLE Cancer Hospital and was diagnosed with carcinoma of the pyriform sinus, where she was undergoing radiotherapy and was referred for physiotherapy. On examination, she had chest secretion, cough, breathlessness, and generalized body weakness that led to functional limitations. Pre- and postfunctional assessment was done with the help of Functional independence measure (FIMS) scale. A 10-day physiotherapy intervention was given and post intervention evaluation showed an increased functional level.
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Dengue fever in a joint family of Belgaum p. 43
Mahantesh Babanna Nagamoti, Vijaylaxmi Kulgod, SL Hoti
Dengue has emerged as a global health problem, as evidenced by epidemics year after year, throughout the tropical and subtropical regions of the world. In India, it has been reported from all the regions, and all four serotypes are circulating with varied severity. Herewith, we are reporting dengue fever in large united family involving six members of the family suffering from den serotype 3.
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Effect of motor relearning program poststem cell therapy in chronic stroke p. 46
Jorida Fernandes, Sanjiv Kumar
A 59-year-old male, with chronic hemiplegia, received the first dose of stem cell therapy 1 year back. Physiotherapy was started immediately. The patient was evaluated using Fugl-Meyer assessment scale and functional independence measure before and after physiotherapy. After 6 months of physiotherapy intervention using motor relearning program, improvements were observed in the motor outcome with significant changes in the upper extremity, especially the hand component.
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Isolated pleural metastasis in a postoperative case of renal cell carcinoma p. 49
Saika Amreen, Shazia Bashir
Renal cell carcinoma is a common malignancy with nephrectomy as a promising treatment. However, it has predisposition toward distant metastasis. This case highlights the significance of active surveillance in these patients to detect rare sites of metastasis such as isolated pleural metastasis.
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Lumbosacral plexopathies associated with acetabular fracture p. 52
Patpiya Sirasaporn
Lumbosacral plexopathies are of considerably less epidemiologic common prevalence than brachial plexus. The most common form of trauma resulting in lesions affecting the lumbosacral plexus is injuries to sacroiliac region. The symptoms which are caused by compressing lumbosacral plexus are sensory disturbance and weakness in an affected leg. The author reports a case of a 65-year-old male with a history of right acetabular fracture status post open reduction and internal fixation by plate and screw who complained weakness and numbness in the right leg. Four months later, he still had difficulty in walking and felt paresthesia at the right lateral thigh and entire of the right foot. His further investigation which was electrodiagnostic study was diagnosed as right lumbosacral plexopathies.
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Aplastic anemia in a patient with chronic liver disease p. 55
Deepak Rajkumar Vangipuram, Sudagar Singh, Sivaprakash Varadan, Damodharan Jayachandran
The association of aplastic anemia with chronic liver disease is rare. We report the case of a 47-year-old male patient who presented with bleeding gums and melena. He was found to have pancytopenia and on evaluation, had an aplastic bone marrow. He also had cirrhosis with portal hypertension (cryptogenic cirrhosis) for which no cause could be ascertained. This case illustrates that in a patient with cirrhosis and pancytopenia, we must look for causes other than hypersplenism.
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Revisted Blocksom vesicostomy: Operative steps p. 58
Rajendra B Nerli, Ranjeet A Patil, Shridhar C Ghagane
Posterior urethral valves (PUVs) are the most common cause of infravesical outflow obstruction in boys. Vesicostomy is considered in selective cases of PUV as an initial temporary procedure. The most commonly followed procedure is the one described by Blocksom. The procedure is simple and easy to perform. We revisited this procedure and describe the operative steps.
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