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   Table of Contents - Current issue
Coverpage
November-December 2019
Volume 12 | Issue 6
Page Nos. 481-556

Online since Thursday, October 17, 2019

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EDITORIAL  

Plagiarism detection: Perils and pitfalls Highly accessed article p. 481
Amitav Banerjee
DOI:10.4103/mjdrdypu.mjdrdypu_132_19  
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COMMENTARY Top

Plagiarism: An academic concern Highly accessed article p. 483
Subhashish Das
DOI:10.4103/mjdrdypu.mjdrdypu_113_19  
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VIEWPOINT Top

The Atypical Antipsychotics as a New Generation Class of Antidepressants in Clinical Practice p. 484
Olumuyiwa John Fasipe, Oluwatosin Beatrice Ibiyemi-Fasipe
DOI:10.4103/mjdrdypu.mjdrdypu_259_18  
This study was designed to announce and discuss the atypical antipsychotics as a new generation class of antidepressants that had bring forth significant improvement and positive outcome to the management of patients with depressive disorders in clinical practice. Furthermore, there is opportunity for antidepressant activity to arise through a novel mechanism of action as in the case of atypical antipsychotics. In addition, this article further justifies the current pharmacological standpoint of view with respect to repurposing of the atypical antipsychotics as emerging antidepressant agents for the treatment of depressive disorders in clinical practice. From the psychopharmacological point of view, an atypical antipsychotic is efficacious as a sole monotherapy or adjunct-augmenting pharmacotherapeutic agent for the treatment of patients having anxious depression disorders (that is, either major depressive disorder [MDD] or bipolar depression or schizoaffective/psychotic depression with anxiety disorder component). The atypical antipsychotics appear to be more consistently effective in the treatment of bipolar depression and also do not increase the risk of inducing mania or increasing the frequency of bipolar cycling. In fact, patients with depressive disorders tend to even respond far better and become clinically more stable (undergo remission faster) on an atypical antipsychotic alone as monotherapy compared to the other old conventional antidepressant agents, such as tricyclic antidepressant, selective serotonin reuptake inhibitor (SSRI), or serotonin–norepinephrine reuptake inhibitor (SNRI) alone. This is one of the main reasons behind the Food Drug Administration (FDA) approval of a fixed-dose combination of an SSRI with the atypical antipsychotics such as fluoxetine and olanzapine. A fixed-dose combination of an SSRI with the atypical antipsychotics such as fluoxetine and olanzapine has received the FDA approval for the pharmacotherapy of MDD, acute bipolar depression, and schizoaffective (psychotic) depression. Furthermore, a fixed-dose combination of sertraline and aripiprazole is currently undergoing clinical trial investigation for the same indications.
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ORIGINAL ARTICLES Top

Retrospective review of presentation of newly diagnosed children with diabetes mellitus in a Nigerian rural setting p. 490
Umar Isa Umar, Isyaku Lawal Muhammed, Ibrahim Aliyu
DOI:10.4103/mjdrdypu.mjdrdypu_227_18  
Background: Diabetes mellitus (DM) is the common endpoint of a variety of disorders of insulin production and/or insulin action resulting in hyperglycemia with associated abnormalities of carbohydrate, fat, and protein metabolism. Presentation with diabetic ketoacidosis (DKA) may be associated with significant morbidity and mortality in the pediatric population. Objective: The objective of this study was to examine the pattern of presentation of newly diagnosed children with DM in a rural setting. Design: It was a retrospective study of case files of newly diagnosed children with DM. Patients and Methods: It was a retrospective review of case files of children younger than 18 years with diagnosis of DM, over a 2-year period (from November 1, 2015, to October 31, 2017) at Federal Medical Centre Nguru, Yobe State, North-Eastern Nigeria. Results: A total of 3289 patients were seen during the study period, of which 6 were diagnosed with DM, giving a case prevalence rate of 1.8/1000. The mean age at presentation was 11.1 (±0.8) years, and there were four males and two females among the patients. All of the patients presented in DKA, and other prevalent presenting features were polyuria (6, 100%), polydipsia (6, 100%), dehydration (6, 100%), weight loss (100%), fever (83.3%), and weakness (4, 66.7%). Two of the six patients with DKA died from cerebral edema, and one had acute kidney injury during admission. Conclusion: Presentation with DKA is common in this setting despite the glaring symptoms of DM, such as polyuria, polydipsia, and weight loss. This highlights the need for intensified efforts in education of health workers and the populace at large for quick recognition, presentation, and prompt diagnosis for optimal management of childhood DM.
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Prevalence of stress and its relation to different precipitating factors among urban females of reproductive age group in Burdwan, India p. 495
Arunima Chaudhuri, Manjushree Ray
DOI:10.4103/mjdrdypu.mjdrdypu_232_18  
Background: Women in emerging economic and social markets are more stressed than those in developed countries. Aims: We aimed to study the prevalence of stress and its relation to different precipitating factors among urban females of reproductive age group. Materials and Methods: This descriptive cross-sectional study was conducted in a tertiary care center of West Bengal after taking institutional ethical clearance and informed consent of the participants. A sample of 7500 women was selected after proper randomization using an online randomizer. On the first appointment, history of the participants was carefully taken, pulse and blood pressure were recorded, and body mass index (BMI) and waist/hip (W/H) ratio were measured. Parameters assessed were Presumptive Stressful Life Events Scale (PSLES) scores and Perceived Stress Scale (PSS) scores. Results: Among 7500 participants, 3245 (43.27%) had mild-to-moderate stress and 4255 (56.73%) had severe stress. Mean ± standard deviation value of PSLES score of participants recruited for the study was 237.99 ± 79.45, and PSS score was 23.76 ± 5.24; there was a positive correlation between PSLES scores and PSS scores with r = 0.8. There was no significant difference in age between the two groups (22.8 ± 3.22 vs. 22.64 ± 3.15; P= 0.26). There was a significant difference in PSLES scores between the two groups (312.93 ± 27.19 vs. 162.99 ± 25.63; P < 0.001). There was a significant difference in values of PSS scores, BMI, W/H ratio, and pulse rate between the two groups. Marital conflicts, family conflict, and conflict with laws were the highest percentages of problems reported by these groups of participants as cause of stress. Conclusions: We observed that 100% of our participants were stressed, and family conflict, marital conflict, problems with in-laws, and abuse by husbands were some of the main contributors of stress in the population studied. Stress levels are increasing in females and require early intervention. To address gender disparities in mental health, multiple actions need to be implemented at various levels. In particular, national mental health policies must be developed that are based on an explicit analysis of gender disparities in risk and outcome.
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Investigation of a cancer cluster in an industrial area of North India p. 503
Vijay Kumar Barwal, Shishupal Singh Thakur, Sanjay Kumar, Salig Ram Mazta, Anmol Gupta, Ankit Chaudhary
DOI:10.4103/mjdrdypu.mjdrdypu_240_18  
Introduction: Cancer clusters always get a lot of attention in the media. It is an aggregation of relatively unexpected high number of cancer cases. People become concerned that a cancer cluster exists in a certain community and that it is caused by some type of carcinogen that is being released into the environment. We investigated a similar concern regarding suspected clustering of cancer cases in an industrial area of a district in North India. Materials and Methods: A retrospective cohort study was carried out from March 1, 2016, to May 31, 2016 taking the whole study area population as exposed. House-to-house search of cancer cases was undertaken retrospectively from the year 2011 onward. The total population of the cohort (denominator) was taken from the census of India 2011 data. Age-adjusted standardized rates were calculated. Results: A total of 53 cancer patients were identified. A maximum number of cases were of the lip and oropharynx (15.1%), followed by the lung (13.2%) and esophagus. The yearly incidence of cancer for both sexes ranged from 87.2 to 90.9/lakh population. The 5-year period prevalence for both sexes was 207.4/lakh population. Conclusion: This panic occurred due to a list of cancer cases given to the health department by the residents and public representatives of the area. As these were just figures without a denominator, it gave a false impression of a high number of cancer cases. However, on conducting this study, we found the age-adjusted cancer incidence to be similar or even lower than the Global Cancer Incidence, Mortality and Prevalence, and Indian Council for Medical Research figures for India. Hence, we ruled out a true cancer cluster.
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Knowledge, attitude and practices of health care workers in biomedical waste management in a newly opened tertiary care hospital p. 508
Sunite A Ganju, Lata R Chandel, Anupama Sharma, Rajinder Singh, Nisha Kumari, Aman Bhatia
DOI:10.4103/mjdrdypu.mjdrdypu_233_18  
Background: Biomedical waste management (BMWM) and adoption of standard work precautions are core strategies in infection control. For effective implementation of infection control practices, capacity building of various stakeholders in BMWM is essential. This study evaluates the impact of training on BMWM and infection control practices in cleaning personnel and technical staff. Methods: Two categories of health-care workers were trained on infection control management and BMWM. A pre- and posttest was administered in both groups. Results: On posttest evaluation, the knowledge showed significant improvement. This could be assessed as a modification of attitude and practices during handling of BMW shown on audit done on routine rounds of hospital conducted by the infection control committee. Conclusion: We recommend that evaluation of training is critical for effective implementation of trainings.
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Blood pressure trends in idiopathic steroid-sensitive childhood nephrotic syndrome: A prospective observational study p. 511
Moumita Samanta, Madhumita Nandi, Srirupa Bhattacharya, Abhisek Naskar, Mrinal Kanti Das
DOI:10.4103/mjdrdypu.mjdrdypu_262_18  
Background: It has been observed that blood pressure (BP) tends to rise in children with idiopathic nephrotic syndrome (NS) in the acute stage, during attack or relapse, and may reverse back to normal with time. However, there is a lacuna of knowledge regarding the actual trend of BP in these children when they are in medication-free period. The study was conducted to analyze the trend of BP in these children as persistent hypertension (HTN) is an important determinant of future cardiovascular morbidity. Materials and Methods: This was a prospective observational study over 6-month duration in children with diagnosis of idiopathic childhood NS wherein BP recordings were followed up and HTN was managed with medications if required. The secondary causes of HTN and steroid-resistant, steroid-dependent, and frequently relapsing NS were excluded. Results: At initial presentation, 36.4% of children had elevated BP of which 9.0% needed antihypertensive drugs. The corresponding values at remission were 66.6% and 15.15% with a declining trend seen in follow-up. Antihypertensive medications had to be given to 22 (33.33%) children for a mean duration of 30.5 ± 21.8 (range: 7–105) days. There was a significant relation between nadir of serum albumin at the time of attack and number of days to go into remission with incidence of HTN (<0.05). Conclusions: Meticulous tracking of BP is essential in children with idiopathic NS as elevated BP, although to a milder degree, is noted in a significant percentage of these children.
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CASE REPORTS Top

Uncommon tumor with rare variant: Cystic struma ovarii – A case report with review of literature p. 516
Veer Karuna, Priya Gupta, Nidhi Verma, Amod Kumar Saroj
DOI:10.4103/mjdrdypu.mjdrdypu_182_18  
Struma ovarii is a very unusual and rare type of monodermal teratoma presenting as a solid pelvic mass. Struma ovarii concurrently occurring with cystic variant is rarely reported. To the best of our knowledge, only 4–5 cases of cystic struma ovarii have been reported in the past two decades. In exceptionally rare cases, it can be malignant. We present an ovarian teratoma which was grossly partially solid and partially cystic filled with mucoid content, causing the diagnosis of struma ovarii to be unnoted. There may be the source of many diagnostic problems if the microscopic examination showed flattened cystic wall with entrapped minimal thyroid follicles in counterpoint to struma ovarii resulting in confusion with other cystic ovarian tumors. No other component of mature teratoma was found in the present case. Presence of a few thyroid follicles and flattened epithelial lining needs extensive sampling and immunohistochemical staining for thyroglobulin and thyroid transcription factor-1 to establish an exact diagnosis. The aim of this literature is to delimitate cystic struma ovarii rarity and for the diagnostic dispute encountered.
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Clear cell hidradenoma: Report of three cases p. 521
Rashmi B Aderao, Uddhao S Zambare, Swagata A Tambe, Chitra S Nayak
DOI:10.4103/mjdrdypu.mjdrdypu_119_18  
Clear cell hidradenoma is a benign eccrine gland tumour with rare incidence of malignant transformation. It is more commonly seen in adult females in the second to fifth decades. Head and face are the most common sites. On histopathology, tumour shows periodic acid–Schiff-positive clear cells and polyhedral cells. Recurrence rate is low if the lesion is completely excised. Here, we report three cases of clear cell hidradenoma presenting as a solitary nodule on the neck, scalp, and chest.
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PHACES syndrome – A rare case report p. 524
Sujit Das
DOI:10.4103/mjdrdypu.mjdrdypu_151_18  
PHACES syndrome stands for posterior fossa malformations–hemangioma–arterial anomalies–cardiac defects–eye abnormalities–sternal cleft all together known as “PHACES syndrome.” It is a rare cutaneous condition characterized by multiple congenital abnormalities. It affects girls nine times more often than boys. A 3-year-old girl presented with hemangioma of the face, palate, lips, and eyelids and developmental delay associated with seizure episodes. In the ocular examination, congenital cataract, choroidal coloboma, and optic disc hypoplasia were seen. Systemically, there were sternal cleft, ventricular septal defect, and posterior fossa arachnoid cyst and central nervous system vascular abnormalities. Diagnosis was made from systemic examination and ocular examination along with imaging study of the head and chest. PHACES syndrome needs to be managed by a multidisciplinary team of experts such as cardiologist, ophthalmologist, neurologist, and neurosurgeon. Every child with PHACES syndrome should be evaluated for glaucoma and associated pituitary function at each visit.
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Cystic thymoma presenting as recurrent empyema p. 529
Lata Sampatrao Rajwad, Ketaki Vasudeo Utpat, Unnati Desai, Jyotsna Madanmohan Joshi
DOI:10.4103/mjdrdypu.mjdrdypu_212_18  
The lymphoma, thymoma and germ cell tumour are most common anterior mediastinal tumours. Thymoma account for 20% of mediastinal tumours and is the most common anterior mediastinal tumour. According to the 2015 WHO classification, the thymomas are classified according to 2 major features namely the shape of the epithelial cells and second is the amount of immature lymphocytes. Cystic thymoma is a rare variant of thymic neoplasm characterized by almost complete cystic degeneration with mixed internal structure. The clinical demeanour can range from an incidentally detected radiological finding to grave Para thymic syndromes. We herein describe a case of a 38 year-old male who presented with recurrent empyema. A contrast enhanced computed tomography of thorax done in the diagnostic workup unveiled a mediastinal cystic mass in right cardio phrenic angle. Mediastinal thymomas may rarely undergo cystic and necrotic changes and present as recurrent empyema's seen in our case.
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Multiple intraosseous capillary hemangiomas of the foot: An uncommon entity p. 533
BM Naveen, Anjan Prabhakara, MG Manoj, Sunil Hegde
DOI:10.4103/mjdrdypu.mjdrdypu_220_18  
Hemangiomas are benign vascular lesions made up of blood vessels, commonly seen in the skin, muscle, bone, and viscera. Intraosseous hemangiomas are rare, and the foot is a very uncommon location of these tumors. These can be symptomatic or asymptomatic. A 26 year old female patient reported to us with insidious onset of pain in the right foot for 10 years followed by swelling on the outer aspect of the forefoot. Radiographs and magnetic resonance imaging evaluation showed a predominantly lytic lesion in the head of the fifth metatarsal, with similar lesions at various other places in the foot. She was treated with complete excision of the tumor from the head of the fifth metatarsal following which she has resolution of symptoms. Biopsy of the specimen revealed capillary hemangioma. This case report affirms that, though uncommon, it should be kept as one of the differential diagnosis in the evaluation of lytic lesion of the foot.
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Chromoblastomycosis causing osteolytic lesion in foot p. 537
Sarvodaya Tripathy, Pritilata Panda
DOI:10.4103/mjdrdypu.mjdrdypu_250_18  
Chromoblastomycosis is a fungal infection involving the subcutaneous tissue. Chromoblastomycosis occurs mostly due to traumatic inoculation of the fungal pathogen and generally remains restricted to the skin and subcutaneous tissue. Bone involvement is rather rare. Considering the vulnerability to trauma in agriculture-dependent countries like India, where trauma is mostly sustained during agricultural work, this clinical entity is of public health importance. We present the case of an adult male, who developed chromoblastomycosis of the foot with contiguous bone involvement showing osteolytic lesions.
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Cytological diagnosis of metastatic ovarian carcinoma in a young female presenting as Sister Mary Joseph's Nodule p. 540
Venu Ghodasara, Navatha Vangala, Tara Roshni Paul
DOI:10.4103/mjdrdypu.mjdrdypu_243_18  
Sister Mary Joseph's nodule (SMJN) is a rare manifestation referring to a malignant metastatic umbilical nodule. It is a sign of advanced stage of malignancy and can be the earliest sign even before detection of primary malignancy. This case report describes a young female with metastatic high-grade ovarian serous carcinoma presenting as SMJN diagnosed on cytology.
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Giant pulmonary hamartoma with foci of placental transmogrification of the lung p. 544
Komal Sawaimul, Namrata Patro, Charusheela Gore, Archana Chirag Buch
DOI:10.4103/mjdrdypu.mjdrdypu_245_18  
Pulmonary hamartoma is the most common benign tumor of lung which is composed of mesenchymal tissues and entrapped respiratory epithelium. The size usually varies between 1 and 5 cm, and it commonly occurs in the sixth and seventh decade, with only 6% of cases seen under the age of 30 years with male preponderance. These lesions are indicative of an abnormal proliferation and mixing of the normal components present in the lung tissue. “Placental transmogrification of the lung” is an extremely rare disease entity, with only <30 cases documented till date. The etiology and pathogenesis still remain unclear. Placental transmogrification is a condition where the alveoli resemble the chorionic villi of placenta. This case is presented to highlight the unusual large size (21.5 cm × 18 cm × 11 cm) of pulmonary hamartoma in a young female (32 years) showing areas of placental transmogrification on microscopy. Awareness of this rare entity will help in making definitive diagnosis.
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A case of non-healing ulcer by Corynebacterium striatum p. 547
Kanwaljit Kaur, Prasanta Sengupta, Deepak Vashisht, Priyanka Pandit
DOI:10.4103/mjdrdypu.mjdrdypu_257_18  
Corynebacterium diphtheriae is well known to cause pathogenicity in humans as well as animals but other species of genus Corynebacterium are considered Diphtheroids and disregarded as commensals. But these good bacteria can become bad whenever immunosuppression takes place. Few authors have reported a negative experience by not giving them due importance. Corynebacterium striatum is one such diphtheroid which was isolated in our institute from a case of non-healing ulcer. The timely isolation and appropriate antibiotic led to complete recovery of the individual.
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Dirofilariasis mimicking as a breast tumor: A report of two cases p. 550
HL Kishan Prasad, Chandrika Rao, Lancelot Lobo, Anitha Chakravarthy, Sachidananda Prabhu, K Jayaprakash Shetty
DOI:10.4103/mjdrdypu.mjdrdypu_239_18  
Dirofilariasis is a zoonotic filarial parasitic infestation. Its prevalence has increased in recent times. Hence, it is described as an emerging zoonosis. However, not many cases of subcutaneous manifestation of the disease have been reported in the literature. Here, we are presenting two cases of dirofilariasis manifesting as a breast mass causing a diagnostic dilemma in treating clinician. We present two cases of dirofilariasis in the breast tissue mimicking a tumor initially, and on histopathology, it was diagnosed as a Dirofilaria infestation. The increased incidence of Dirofilaria infestation in the Southern part of the country has created a need for increased awareness among the population living in endemic areas to reduce the load of the parasite. Hence it is an ideal time to initiate the primary preventive measures to reduce the incidence of Dirofilaria infestation.
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LETTERS TO THE EDITOR Top

Negative images of mycobacteria in cytology p. 553
Rashmi Patnayak, Itishree Chowdhury
DOI:10.4103/mjdrdypu.mjdrdypu_16_19  
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Oromandibular dystonia and botulinum neurotoxin: An overview p. 554
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
DOI:10.4103/mjdrdypu.mjdrdypu_254_19  
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Reviewing process in medical journal: Ethical aspects p. 555
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/mjdrdypu.mjdrdypu_85_19  
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