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   Table of Contents - Current issue
July-December 2018
Volume 23 | Issue 2
Page Nos. 51-108

Online since Thursday, October 11, 2018

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Swasth Bharat, Samriddha Bharat Highly accessed article p. 51
Omprakash Gupta
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Practical application of microRNA markers in the diagnosis of multiple sclerosis in the realm of routine clinical neurology p. 53
Robert A Ollar
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Palliative care in India: Trials, tribulations, and future prospects p. 55
Vishakha Jain
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Can toothpaste carry drugs to fight pulmonary infections? p. 59
Firoz Naem Khan, Vijay Thawani
Toothpastes have been used as vehicles to deliver drugs in the oral cavity. Scientists delivered antibiotics to oral cavity through toothpastes and postulated that toothpastes may also be used to deliver antibiotics to tackle fatal lung diseases. Cystic fibrosis is a rare lung disease due to genetic disorder which results in excess mucus production in the lungs. This lung infection is treated with antibiotics which are given intravenously, inhaled, or given orally. Positive results have been reported with antibiotics in toothpastes, which can be extrapolated to deliver these for pulmonary diseases.
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Management of diabetes in elderly p. 61
Rini Yadav, Ashish Goel
The population of elderly people is expected to rise significantly over the coming years. The prevalence of Diabetes is also increasing in elderly. In view of co-morbidities present in elderly diabetics the approach to manage diabetes in them vary significantly from that I younger population. To facilitate better management the International Diabetic Federation has classified diabetics in to three categories. The lifestyle modification and self-management education are the cornerstones. As far as possible poly pharmacy should be avoided. Beside pharmacological therapy, a multidisciplinary and holistic approach is needed to manage diabetes in elderly.
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Nipah virus: Biology, disease, treatment, control, and prevention p. 65
Rahul Narang
Nipah virus (NiV), an RNA virus, belongs to genus Henipahvirus of family Paramyxoviridiae. First isolated and identified in Malaysia in 1999, NiV affects humans as well as animals such as pigs, cattle, cats, dogs, ponies etc. Fruit bats of genus Pteropus serve as reservoir host for NiV. Bangladesh has experienced almost annual outbreaks while there have been few outbreaks in India, the latest was in Kerala state in 2018. NiV has become an important human pathogen causing acute encephalitis syndrome associated with high mortality. Central nervous and respiratory systems are involved mainly along with multi-organ vasculitis and infection of endothelial cells. In early stages of disease, laboratory diagnosis can be made by isolation as well as real time polymerase chain reaction (RT-PCR) from throat swabs, nasal swabs, cerebrospinal fluid, urine and blood. In later stages, serological tests for antibody detection using ELISA are useful. Immuno-histochemistry on tissues collected after autopsy can also be performed. There is no specific treatment available for this infection and supportive therapy along with barrier nursing is mode of treatment. Monoclonal antibodies and vaccines against NiV have been found effective in animals but are yet to be tested in humans. The infection can be prevented in endemic areas by reducing exposure to fruit bats, pigs and date palm sap.
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Late-onset neonatal sepsis: Overview of risk factors and bacterial etiology in a tertiary care hospital in North India p. 69
Sunit Pathak, Dipti Agarwal, Pratibha Singh, Meenakshi Pathak, Shamrendra Narayan
Background: Septicemia in neonates is one of the leading causes of mortality. The increasing number of multidrug-resistant pathogens is a serious concern. With this background, this study was done to evaluate the risk factors of late-onset sepsis (LOS) (community- and hospital-acquired infections) in newborns and to determine the antibiotic resistance pattern of the isolates in these infections. Materials and Methods: This retrospective study was conducted at Sarojini Naidu Medical College, Agra, on newborns admitted between August 2015 and January 2016. Newborns with the final diagnosis of sepsis obtained from the case records during the study period were included in the study. Those newborns with positive blood culture results were included in the study. Clinical details and antibiotic sensitivity of the isolates were also obtained from the records. Results: Sixty-eight newborns with LOS (38 community- and 30 hospital-acquired infections) were included in the study. Staphylococcus and Klebsiella were the most common bacteriological isolates for both community- and hospital-acquired infection cases in 36%, 26% and 26%, 33.3%, respectively. Home delivery (52.6%) and faulty breastfeeding were (57.8%) seen in significantly larger numbers in community-acquired infections (P = 0.03 and 0.01, respectively) whereas invasive procedures such as intubation were seen in 40% of nosocomial infections as compared to only 5.2% of community-acquired infections. Antibiotic susceptibility pattern in both the infections was similar. Staphylococcus aureus was susceptible to vancomycin in 100% cases while high resistance was seen for ampicillin in both the groups. Similarly, gentamicin was found to be resistant in both the groups for Klebsiella while imipenem was susceptible in 100% cases. Conclusion: Both community- and hospital-acquired infections had similar isolates and antibiotic susceptibility pattern; however, the risk factors associated with both the infections differed.
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Antibacterial and antifungal property of three plants against oral microbes p. 73
Chandana Kalita, Ankumoni Saikia, Ajanta Sarma, Kasturi Saikia, Anjanamoyee Saikia, Anjan Kumar Saikia
Introduction: Use of medicinal plants to cure diseases has been practiced throughout the world. This is more common among the rural population as the reach of modern health-care facility is very little toward them. Rural population treats or manages different oral disease with the locally available herbs, which has been used traditionally. Among them, tulsi, neem, and Pochotia are most commonly used herbs in Assam. Aim: The aim of the study was to find out antibacterial and antifungal properties of Tulsi, Neem, and Posotia against few isolated oral microbes. Materials and Methods: Three commonly used plants – tulsi, neem, and Pochotia taken for antimicrobial study. Twigs dried and powdered and extract made with water and acetone. Microorganisms were isolated from the oral swab taken from the patient attending Out Patient Department of Regional Dental College, Guwahati. Antibacterial and antifungal potential of these plants was observed using agar well-diffusion method. Results: Tulsi and Pochotia showed antibacterial activity against Streptococcus mitis and Streptococcus viridans, whereas neem extract showed inhibitory effect against Klebsiella species. Neem and Pochotia showed antifungal action against Candida albican in both aqueous and acetone extract. The positive control of ciprofloxacin and itraconazole produced significant size of the inhibition zone. Statistical analysis was done using Instat Software. For comparing means, F-test was applied and considered P < 0.05 to be significant. Conclusion: Antimicrobial essay showed the antibacterial and antifungal action of these plants against oral microbes. It is important to identify and isolate the proper constituent responsible for this mechanism.
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Utility of ST score on admission as a marker for outcome in acute myocardial infarction in a resource constrained setting p. 77
Udit Narang, OP Gupta, Jyoti Jain, SP Kalantri, Sandeep Joshi, Suyash Bhadoriya
Introduction: An early and specific indicator is needed to prognosticate acute myocardial infarction (MI). This indicator should be simple, quick, reliable, non-invasive, inexpensive, and easily applicable to all the patients especially in a resource-constrained setting. The present study tried to evaluated efficacy of ST score on electrocardiography as a prognostic indicator in acute ST-elevated MI (STEMI). Materials and Methods: A prospective study was conducted on consecutive thrombolysed patients of STEMI admitted in teaching hospital. ST score defined as sum of ST-segment elevation in all leads related to infarct location was calculated in standard 12-lead electrocardiographic tracings immediately on admission and then serially postthrombolysis at 90 min, 6 h, 24 h, and day 3 and 5 of admission. Primary end-point was all-cause mortality at 30 days. Results: The mean ST score between survivor and nonsurvivor was 19.27 mm and 16.16 mm, respectively. The score on admission in patients who had poor outcome was significantly higher than those who had good outcome (poor = 20.27 mm vs. good outcome = 12.47 mm; P = 0.002). This difference persisted throughout but was maximum at 90-min postthrombolysis (13.82 mm vs. 7.39 mm; P = 0.0001). The optimal cutoff point maximizing sensitivity and specificity was found at 11 mm for both anterior- and inferior wall MI (IWMI) with a sensitivity of 73% and specificity of 58%. Conclusion: This study concludes that an increase of 1 mm in ST score increased the odds of complications by 1.06 (95% confidence interval [CI], 1.01–1.2) for anterior-wall MI and by 1.09 (95% CI, 0.96–1.2) for IWMI. In a resource-constrained health facility where electrocardiography may be the only available equipment, ST score can easily and effectively be used to stratify patients into high-risk and low-risk categories.
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Serum calcium deficiency and bone mineral density in patients on long-term anti-epileptic therapy p. 84
Parag Rahatekar, Rajashree Khot
Introduction: Epilepsy is a common chronic neurological disorder, usually requiring long-term treatment with anti-epileptic drugs (AEDs). AED therapy is associated with metabolic bone disease and is a major iatrogenic risk factor for fractures. There remains uncertainty about the type(s) of bone disease due to AED treatment and the pathogenesis of AED-associated fractures. The fracture rate in patients with epilepsy is 2–6 times higher than the rate observed in the general population. Only a few studies in India have studied the prevalence of osteopenia in patients on long-term AEDs. Purpose of Study: The purpose of this study is to find out the prevalence of osteoporosis and osteopenia and to correlate serum calcium levels with bone mineral density (BMD) by bone densitometer in patients with epilepsy on long-term AED therapy. Materials and Methods: The study was carried out at Government Medical College and Hospital where 50 cases having epilepsy of more than or equal to 2 years duration and 50 age- and sex-matched healthy controls were taken by comparing BMD and associated parameters. Results: Mean BMD value was low in cases as compared to controls in all age groups with a significant decrease in young age group and as the duration of AED therapy increased the mean BMD decreased.
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Ludwig's angina: Pediatric case report and literature review p. 89
Aditya Pratap Singh, Ramesh Tanger, Vinay Mathur, Arun Kumar Gupta
Ludwig's angina (LA) is a serious, rapidly progressive cellulitis of the floor of the mouth which involves the submandibular, submaxillary, and sublingual spaces of the face; it is life-threatening if not recognized early and complications such as septicemia and asphyxia caused by expanding edema of soft tissues of the neck may occur. A literature review identified 35 pediatric cases of LA with a 14% mortality rate. It occurs predominantly in immunocompetent children with an odontogenic source of infection in a third and unknown source of infection in a third of cases. Many departments may have limited experience of the disease because of its rare occurrence. Hence, it is important to recognize LA in the earlier stages of the disease. We here present a case of huge LA in a 6-month-old male child with a very short history.
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Syndrome of right isomerism: Ivemark syndrome p. 92
Dipti Jain, Bhushan Chavan, Anita Manoj
Heterotaxy Syndrome is a complex syndrome that occurs when the axes of the body fail to rotate correctly when developing in the uterus. This can result in many different organ systems being affected. Cardiac malformations are a major component of heterotaxy syndrome, resulting in significant morbidity and mortality. Abnormal cardiac development typically leads to atrial appendage isomerism, resulting in either bilateral paired right atria (right atrial isomerism or paired left atria (left atrial isomerism. Here we present a one and a half-month-old female child with right isomerism.
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Giant fibroadenoma in postmenopausal female p. 95
Vandana Verma Ahluwalia, Prerna Singh Saharan, Ankita Chauhan
Giant fibroadenoma, with an overall incidence of <4%, is an uncommon variant of fibroadenoma. It is common in adolescent age group but sporadic in the elderly. The important differential is phyllodes tumor of the breast which also presents as rapidly enlarging mass. We herein report a case of a middle-aged woman with an unusually large fibroadenoma in the right breast and vascular calcification in the left breast.
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Gastric outlet obstruction and intussusception following Frey's procedure in a patient with chronic pancreatitis - A case report p. 98
Subair Mohsina, Sathasivam Sureshkumar, Gubbi Samanna Sreenath, Vikram Kate
Most commonly reported postoperative complications of Frey's procedure include sepsis, delayed gastric emptying, and endocrine insufficiency. Here, we report unusual complications such as gastric outlet obstruction and intussusception following Frey's procedure in the late postoperative period. A 40-year-old patient with chronic pancreatitis with common bile duct stricture who underwent Frey's procedure, presented with recurrent vomiting episodes 3 months postoperatively. Contrast-enhanced computed tomogram (CECT) abdomen showed features of gastric outlet obstruction. A gastrojejunostomy was carried out. The patient was asymptomatic for 2 months following which the patient presented with features of jejunojejunal intussusception confirmed on CECT, which was managed conservatively. The patient remains asymptomatic on follow-up for the past 9 months. Our experience reveals that although reports of such complications following Frey's procedure are rare, gastric outlet obstruction and intussusception can occur following Frey's procedure, and hence, the surgeon should have an index of suspicion in patients with atypical presentation.
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Osteoma of frontal sinus p. 101
Divya Gupta, Pankhuri Mittal, Kavita Goyal, Ishwar Singh
Osteomas are benign, slow-growing tumors found commonly in craniomaxillofacial region. Clinically, they may remain asymptomatic because of their small size or may become symptomatic because of enlargement, erosion, or compression of structures in the vicinity. Treatment is needed in frontal sinus osteomas causing symptoms or having immediate potential to cause complications. The treatment approach can be closed or open depending on the size, location, and frontal recess area occupied by the tumor. We present two cases of frontal sinus osteoma with varied presentations at the two ends of clinical spectrum and discuss the management protocols.
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Retroperitoneal paraganglioma: A case report with review of literature p. 104
Mahmood Dhahir Al-Mendalawi
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Integrated medicine p. 105
OP Gupta
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Prof. Narendra Nath Wig p. 106
Prakash B Behere
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Erratum: Noble prize in physiology or medicine 2017 p. 108

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