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   Table of Contents - Current issue
January-February 2019
Volume 12 | Issue 1
Page Nos. 1-94

Online since Tuesday, January 22, 2019

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Publications pressures, difficulty of being good, and the Sunday gentleman Highly accessed article p. 1
Amitav Banerjee
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Unsolicited academic invitation to young Indian authors and a way to limit it: A prospective cohort study Highly accessed article p. 4
Shaikat Mondal, Himel Mondal, Sarika Mondal
Background: E-mail addresses of the corresponding author can be accessed from open-access online articles. These addresses are commonly collected by journal promoters and used to send invitations to authors with attractive publication offer to allure young authors. Aim: The aim of this study was to ascertain the quantity and type of unsolicited academic invitations and to find the effect of an intervention on the reduction of quantity of invitations. Materials and Methods: A total of seven young authors had participated in the study. In preintervention phase, each Sunday, the authors counted their unsolicited e-mails and reported it for consecutive 6 months. A list of commonly used words/phrases in those e-mails was made. That list was used to make e-mail filters to divert unsolicited e-mails to a different label (SPAM STUDY). In postintervention phase, the participants reported the number of unsolicited e-mails received in different labels for consecutive 3 months. Results: The authors received average 5.27 ± 0.93 (2.04 ± 0.28 in inbox and 3.23 ± 0.89 in spam label) academic invitations per day in the preintervention phase. Majority of the e-mails (98.97%) requested for submission of the manuscript. Postintervention total unsolicited academic e-mails (5.43 ± 1.25) remain unchanged (P = 0.67); however, e-mails to inbox (0.08 ± 0.02/day) were significantly (P < 0.0001) decreased. Conclusion: Young authors receive lots of unsolicited academic invitations; most of them request to submit manuscript. These unsolicited e-mails can be diverted to a different e-mail label by creating e-mail filters. This would help authors to reduce the burden of unsolicited mails in inbox.
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Assessment of vascular reactivity in young diabetics by cold pressor test and heart rate variability p. 11
Musharaf Bashir, Riyaz Ahmad Lone, Imran Nazir Salroo, Sheikh Imran Sayeed
Background: Diabetes mellitus (DM) is one of the common causes for autonomic dysfunction. Increased duration of the disease further increases the risk of neuropathy. The cold pressor test (CPT) and heart rate variability (HRV) are two noninvasive tests which are used to study the vascular reactivity. Aim: This study aimed to assess the vascular reactivity in young diabetics with the help of CPT and HRV. Materials and Methods: This study included sixty young adolescents aged 16.71 ± 2.85 years. Thirty adolescents who were diagnosed with type 1 DM (T1DM) were recruited from the outpatient department of endocrinology, and their results were compared with age- and sex-matched thirty controls. Vascular reactivity was assessed with the help of CPT and HRV. Results: The change in systolic (23 ± 10.77 mmHg; P < 0.0001) and diastolic blood pressure (24.87 ± 8.63 mmHg; P < 0.0001) at the end of 1 min of CPT was significantly higher in the diabetic group than controls. Fasting blood glucose was significantly higher in the diabetic group (P < 0.0001) as compared to controls. It was also observed that sympathetic activity was significantly higher in the diabetic group (P = 0.003) whereas parasympathetic activity was significantly reduced in the diabetic group (P = 0.03). Conclusion: Adolescents with T1DM have increased vascular reactivity characterized by increased sympathetic and decreased parasympathetic activity. Thus, it may be concluded that young people with T1DM should be screened for increased vascular reactivity which may serve as a predictor of future hypertension in them.
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Acanthosis nigricans: A cutaneous marker for metabolic syndrome p. 16
Nirali Girish Shah, Swapna S Khatu, Neeta R Gokhale, Yuvraj E More, Deepak Khismatrao
Background: Acanthosis Nigricans (AN) is an easily identifiable dermatoses characterized by thickened, hyperpigmented plaques. Metabolic syndrome refers to a clustering of metabolic risk factors including central obesity, glucose intolerance, hyperinsulinemia, low HDL cholesterol, high triglycerides and hypertension. AN is a skin marker associated with this syndrome. Aims and Objectives: This study aimed to determine the relationship between AN and metabolic syndrome by studying its clinico-epidemiological features and also the relation of severity of AN over neck with metabolic syndrome. Methodology: This is a case-control study. One hundred consecutive patients of AN attending dermatology OPD of a tertiary care hospital were included in this study. They were evaluated for AN and severity of AN over neck was assessed. Age and sex matched 100 controls were included in the study. Epidemiological, clinical and anthropometric characteristics (height, weight, waist circumference) were measured of all the cases and controls. Body Mass Index (BMI) was calculated. Fasting Blood Sugar, High Density Lipoprotein and Serum Triglyceride levels were estimated. Result: The average age of the patients was 32.4 years and females (62%) were more than the males (38%). Neck was involved in all the patients. There was statistically significant correlation of increasing severity of AN with each component of Metabolic syndrome. On comparing between cases and controls, each component of metabolic syndrome was raised in cases as compared to the controls. 70% cases had Metabolic syndrome which was statistically significant. Conclusion: There was a high prevalence of AN in subjects with metabolic syndrome. Also there was a positive correlation between severity of AN and Metabolic syndrome.
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Hemophagocytosis in bone marrow aspirates: An indication of hidden pathologies p. 22
Sampath Kolavadi Srinivasagowda, Venkatesan Somasundaram, Vinu Balraam, Reena Bharadwaj
Background and Objectives: Hemophagocytosis in bone marrow aspirates is fairly common and can be observed in a spectrum of clinical conditions. This study aimed at evaluating the clinicopathological profile of patients showing hemophagocytosis on bone marrow aspirates examined for varied clinical indications. Materials and Methods: In this study, all those bone marrow aspirate smears sent with various clinical indications and which showed hemophagocytosis were included. Finally, 25 bone marrow aspirates were studied. Results: Of 25 patients, 18 (72%) were males and 7 (28%) were females. The age of the patients ranged from 2 to 73 years. Two common clinical indications with which bone marrow aspirates were sent were fever of unknown origin 10 (40%) and HIV-positive patients with cytopenias 7 (24%). Anemia was the most common cytopenias observed followed by cytopenias in other combinations. Microcytic hypochromic anemia was the common morphological type of the anemia encountered in these patients 17 (68%). Twenty-three (92%) of the bone marrow aspirates showed cellular bone marrow with features of hemophagocytosis. Bone marrow aspirate from a HIV-positive patient showed erythroid hyperplasia (78% early erythroids) with giant erythroblasts and features suggestive of parvovirus B19 infection and hemophagocytosis. Conclusions: Hemophagocytosis in the bone marrow aspirates should not be overlooked and always be documented and reported. The presence of hemophagocytosis may be the only clue to the underlying conditions such as systemic infections or hemophagocytic lymphohistiocytosis (HLH). It is therefore recommended that every case which shows hemophagocytosis needs to be reported and further workup be done to confirm the diagnosis of HLH.
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Toilet training and parental help-seeking behavior toward elimination disorders: Our experience in a semi-urban setting p. 28
Taslim O Lawal, Godpower Chinedu Michael, Ibrahim Aliyu
Introduction: Elimination disorders consist of enuresis and encopresis. When a child fails to successfully achieve toilet training by the age of five and has repeated voiding of urine on the bed or clothing at least twice per week for at least 3 consecutive months it is called enuresis; while bowel continence if not achieved by age 4 years, is encopresis. This study seeks to determine parental/caregiver concerns and help-seeking behaviors toward elimination disorders. Materials and Methods: This study was cross-sectional and was conducted over a 3-month period from January 2017 to March 2017. Convenience sampling method was adopted, and pretested researchers-administered questionnaires were used. Results: Two hundred individuals were recruited consisting of 104 (52%) males and 96 (48%) females with a male-to-female ratio of 1.1:1. About 194 (97%) of the respondents were aware of elimination disorders, 62 (31.0%) of them reported elimination disorder occurred in their wards, only 24.2% of the caregivers had sought for medical treatment for elimination disorder. Majority of the caregivers did not know the cause of elimination disorder, but 2% of them believed evil spirits were responsible for elimination disorders. Enuresis was the most commonly reported elimination disorder and most occurred at night (80.6%), and none had isolated encopresis. Ethnicity and educational qualification of respondents had no relationship with their help-seeking behavior toward elimination disorder ([Fishers' exact test = 11.337, P = 0.023] and [Fishers' exact test = 8.074, P = 0.089]). Conclusion: Elimination disorders were prevalent; however, few caregivers seek for medical help/treatment, and their help-seeking behavior was not influenced by their ethnicity or educational qualification.
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A study on oral hygiene among students of a secondary school in Harinavi, South 24 Parganas, West Bengal p. 34
Jayeeta Burman, Aparajita Dasgupta, Rajarshi Banerjee, Sembagamuthu Sembiah, Lina Bandyopadhyay, Bobby Paul
Context: It is needless to state that health and hygiene go hand in hand and of the various categories of hygiene, oral hygiene has a colossal contribution to positive health for any individual. Zealous and correct lifestyle characteristics are related to high standards of oral hygiene, and good habits must be inculcated in the early years of one's life. With this background, a study was conducted among some school-going adolescents. Aims: The aim of this study is to find out the status of their oral hygiene and oral health along with their associated risk factors. Methodology: It was a school-based, observational, cross-sectional study conducted among students of standard 7th, 8th, and 9th of the school who were approached, and the parents of 151 students gave their consent for the oral checkup. Students first filled in a self-administered questionnaire following which their oral health and hygiene were examined. Data were analyzed using statistical package of social science software version 16.0 (IBM, SPSS Inc., Chicago, USA) Descriptive statistics and inferential statistics were performed. Results: Among 151 students, 64.2% had poor oral health, 52.3% and 64.2% student had unsatisfactory awareness toward oral health and oral hygiene practice, respectively. Females had better oral health awareness and better practice scores than males. Factors such as satisfactory practice of oral hygiene (odds ratio [OR] = 6.7 [3.4–12.2]); satisfactory awareness toward oral health (OR = 2.9 [1.9–3.5]); and gender (OR = 2.9 [1.5–5.8]) were associated with good oral health. Awareness toward oral health (OR = 5.8 [2.8–12.2]) are also strongly associated with the good practice of oral hygiene. In the final model of multivariable logistic regression analysis, factors such as the practice of oral hygiene (adjusted OR [AOR] = 6.8 [3.2–14.5]) and awareness toward oral health (AOR = 2.1 [1.3–3.6]) retained significance. Conclusion: Oral health promotion programs and periodic health checkups are needed.
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Surveillance of health-care workers for nasal carriage to detect multidrug-resistant Staphylococcus spp. in a tertiary care center: An observational study p. 39
Neelima Kulshrestha, Tanmoy Ghatak, Prashant Gupta, Mastan Singh, Jyotsna Agarwal
Background: Healthcare-associated infection (HCAI) has become a potential risk worldwide. Staphylococcus spp., especially methicillin-resistant Staphylococcus aureus (MRSA) is one of the frequent causes of HCAIs. Coagulase-negative Staphylococcus (CoNS), previously considered as contaminants, now emerged as opportunist nosocomial pathogens for causing HCAIs such as bloodstream infections. Health-care workers (HCWs) play a role in colonizing and transmit microorganism to patient causing HCAIs. The purpose of this study was for surveillance of MRSA and MR-CoNS as nasal colonizer among HCWs and its antimicrobial susceptibility pattern. Materials and Methods: Nasal swabs were collected from 214 HCWs such as doctor, nurse, sweepers, ward boy, and operation theatre (OT) assistant working in Intensive Care Unit and OT and ward. Methicillin resistance among the Staphylococcus spp. isolates were detected using cefoxitin 30 μg disc. Antimicrobial susceptibility profile of the Staphylococcus spp. isolates were also determined for several other antibiotics. Results: Of 214 nasal swabs collected from HCWs, 97.6% of doctors, 93.2% of nurses, and 94.6% of sweepers showed growth of Staphylococcus spp. MRSA was 13%, 6.7%, and 14.2% in samples obtained from anterior nares of doctors, nurses, and sweepers, respectively. MR-CoNS were 41.6%, 32.4%, and 32.1% in samples obtained from anterior nares of doctors, nurses, and sweepers, respectively. Conclusion: Multidrug-resistance Staphylococcus spp. carriage is very high among HCWs in our tertiary care center. Our study created awareness among HCWs by educating them about nasal carriage of MDR organisms.
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Prevalence and correlates of psychiatric comorbidity in chronic pain patients: A hospital-based study p. 44
Archana Jawdekar, Vishal Patel, Suprakash Chaudhury, Daniel Saldanha
Background: There is a paucity of information on psychiatric comorbidity in chronic pain patients in developing countries like India. The present study was undertaken in this context. Aim: The aim of this study is to assess the psychiatric comorbidity in chronic pain patients. Materials and Methods: Fifty adult chronic pain patients without organic cause of more than 6 months duration attending outpatient departments were included in the study with their informed consent. Psychiatric comorbidity was assessed by the Schedules for Clinical Assessment in Neuropsychiatry. Results: Majority (80%) of patients was between 18 and 50 years of age, came from nuclear families (88%), and was married (82%). Majority (76%) of patients had pain <2 years; 56% had moderate pain severity and 54% had moderate functional impairment due to pain. In chronic pain patients, 78% had psychiatric comorbidity; the most common disorder was depression (36%) followed by generalized anxiety disorder (18%), somatoform disorder (16%), and panic disorder (8%) patients indicating that patients with chronic pain are more likely to have mood disorder than other psychiatric disorders. A significant association was seen between psychiatric comorbidity and pain severity but not with sociodemographic characteristics. Psychiatric comorbidity was associated with severity of pain. Head and neck and back pain patients reported high prevalence of depression (39.5% and 36%), while chest pain and limb pain patients had high prevalence of generalized anxiety disorder (45.5% and 33.3%). There was high prevalence of nonspecific symptoms such as localized tension pain (90%) and worry (82%) in chronic pain patients. Conclusion: The high prevalence of psychiatric comorbidity in patients suffering from chronic pain disorders emphasize the need to screen these patients for psychiatric disorders, particularly depression and anxiety. Diagnosis and treatment of comorbid psychiatric disorders will greatly improve the management of chronic pain patients.
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DRUG REPOSITIONING: Revisiting the basic psychopharmacological mechanism of action for agomelatine and where it should be classified? p. 50
Olumuyiwa John Fasipe, Oluwatosin Beatrice Ibiyemi-Fasipe, Peter Ehizokhale Akhideno, Muyiwa Samuel Fageyinbo
Concerning Agomelatine, as of this present moment and deeply analyzing things from the psychopharmacological point of view, the utmost important question yet to be answered is “why should the drug Agomelatine be regarded as an antidepressant agent when it did not actually possess the necessary pharmacoactivities and mechanism of actions that adequately qualified it to be classified under the family of antidepressants as done in previously published reference literatures?” The mystery, approach, and rationale behind this act of classification phenomenon were actually and inevitably putting a square peg inside a round hole, which is scientifically deemed unfit and inappropriate. This act of classification phenomenon makes Agomelatine to be referred to as a paradoxical agent that contradicts itself. Agomelatine is a melatonergic MT1 and MT2 receptors agonist and a selective serotonergic 5-HT2B and 5-HT2C receptors antagonist (MASSA). The 5-HT2B receptors are poorly represented in the central nervous system (CNS) in contrast to the 5-HT2C receptors. Its prochronobiological activity resynchronizes circadian rhythms in experimental animal models of delayed sleep phase syndrome via its melatonergic MT1 and MT2 receptors agonistic effect. By antagonizing 5-HT2C receptors, Agomelatine disinhibits/increases norepinephrine and dopamine release specifically in the neocortical areas such as the prefrontal cortex but neither in the subcortical areas such as the striatum nor nucleus accumbens; therefore, it is sometimes referred to as a norepinephrine–dopamine disinhibitor (NDD). Furthermore, by antagonizing 5-HT2C receptors in the subcortical areas such as basal ganglia, mesolimbic cortex and hippocampus; Agomelatine produces anxiolytic effect clinically. Because Agomelatine lacks inhibitory pharmacoactivity at the monoaminergic reuptake transporter pumps (SERT, NET, and DAT), does not inhibit the enzyme monoamine oxidase, has neither weak antagonist nor partial agonist activity at the dopaminergic D2 receptor, and also lacks antagonistic activity at both the noradrenergic α2-receptor and N- methyl-D-aspartic acid (NMDA)-glutamatergic ionoceptor, it should not be regarded and accepted as an antidepressant but rather it should be classified as an anxiolytic sedative agent on account of its melatonergic MT1 and MT2 receptors agonist and selective serotonergic 5-HT2C receptor antagonistic (MASSA) properties.
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Palatogingival groove: A pathway to periodontal destruction p. 55
Anshul Sawhney, Rajesh Kumar Thakur, Atul Kumar Singh, Bipin Kumar Yadav, Megha Ralli
Palatogingival or radicular groove is another developmental aberration known to maximally affect the palatal surfaces of maxillary lateral incisors but is often missed during a routine. It is a malformation which presents as a groove or channel that begins in the central fossa, crosses the cingulum of the tooth and extends apically to or beyond the cementoenamel junction at varying distances and directions along the root surface. It serves as a perfect bacterial harbor predisposing to pocket formation, concomitant bone loss and pulpal involvement, thereby encouraging the development of endodontic-periodontal lesions. Depending on severity, the groove may render a direct communication between the periodontium and pulp cavity promoting effortless bacterial invasion. It creates an area where plaque accumulation can be difficult, if not impossible to control using oral hygiene measures. The diagnosis of these grooves is quite difficult, as they cannot be differentiated in the X-ray images. The treatment procedures employed for treating palatogingival grooves will include pulpectomy if the tooth is nonvital along with odontoplasty of the groove or restoration of the groove with glass ionomer cement after the elevation of mucoperiosteal flap. Bone defects around the involved teeth also have to be treated with grafts and membrane. This case report describes the diagnosis and treatment of a palatogingival groove on maxillary lateral incisor.
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Face of giant panda sign in space-occupying lesion of brain p. 59
Rajendra Chavan, Avinash Kishore Shah, Girish Ranganath Bhosale
Face of giant panda sign is classically described in Wilson's disease. It is because of high signal intensity in the tegmentum of midbrain with preserved normal signal intensity in the red nuclei, lateral portion of the pars reticulata of the substantia nigra, and relative hypointensity of the superior colliculi. Other causes have also been described in literature, but they are limited.
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Bizarre gastrointestinal foreign bodies: Report of two cases p. 62
Ismail Inuwa Mohammed, Jameel Ahmad Ismail, Nureini Tunde Oyebanji, Nuhu Garba, Amina Ibrahim El-Yakub, Ibrahim Aliyu
Foreign body (FB) ingestion in the gastrointestinal tract (GIT) is commonly seen among children, alcoholics, mentally retarded individuals, prisoners, drug smugglers, and in people wearing dentures. However, about 80% of them excrete the involved FB safely without any significant complication. Observed complications include intestinal obstruction, perforation, bleeding, or fistula formation. Therefore, we present two cases of an unusual presentation of foreign bodies (FBs) in the GIT. The first case was a 14-month-old boy whose complaint was the inability to swallow; the only physical finding was epigastric tenderness, but chest X-ray revealed a radiopaque FB extending from the chest to the upper abdomen; the second case was a 25-year-old man who accidentally swallowed a toothpick, and this perforated the small intestine. Both cases had emergency laparotomy and the FBs were removed.
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Maffucci's syndrome: A rare case report with unusual location p. 65
Shilpa Laxman Patwekar, Swapna Subhash Khatu, Nirali Girish Shah, Neeta Gokhale
Maffucci's syndrome is a rare nonhereditary syndrome characterized by multiple enchondromas and hemangiomas, which is commonly observed over hands and feet. We are presenting a rare case of Maffucci's syndrome in a 13-year-old female with hemangiomas situated over the presternal area, which is an unusual area of involvement.
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Eosinophilic angiocentric fibrosis: A case report with review of literature p. 69
Amruta Ashok Patil, Sagar Jaywantrao More
Eosinophilic angiocentric fibrosis (EAF) is a rare benign condition mainly affecting the nasal cavity. It has characteristic histopathological features as eosinophil-rich perivascular onion skin-like fibrosis. Ours was an interesting case of the right nasal cavity mass in middle-aged male who presented with nasal obstruction. Histopathological features were characteristic of EAF. Treatment with excision of lesion and corticosteroids had no recurrence on 6-month follow-up.
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Natal teeth: An overview and case reports p. 72
Arti Dolas, Neha Deshpande, Tulsi Bahetwar, Ritesh Kalaskar
Natal teeth and neonatal teeth are rare occurrences. In some parts of the world, they are considered as good omen while in some parts as devil's sign. The history of natal teeth dates way back to 23 BC. It causes difficulty in feeding the infant as well as the feeding mother and also possesses the danger of accidental aspiration. This article presents two case reports where the natal teeth were extracted due to the risk of aspiration.
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Head-and-neck squamous cell carcinoma metastasizing to femur-pathological confirmation of a rare site of metastasis of a common cancer p. 75
KR Anila, CT Kainical, Sumod Mathew Koshy, P Sindhu Nair
A 62-year-old man presented with pain in the right hip of 2 weeks. He was a known case of squamous cell carcinoma (SCC) of the right alveolus diagnosed 8 months back, for which he had undergone surgery along with postoperative radiotherapy. An X-ray and computed tomography (CT) study of the hip showed a lytic lesion involving greater trochanter and the diaphyseal region of right femur with destruction of the cortex and showing extracortical soft-tissue component. A CT-guided aspiration and biopsy were done. Meanwhile, the patient was worked up for myeloma, which turned out to be negative. The cytology smears and biopsy showed metastatic SCC. We are reporting this case because distant bone metastasis in the head-and-neck SCC is uncommon.
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Pellagra: A forgotten ailment in current clinical practice p. 78
NS Harsha, BM Suraj, Supreeth S Kanakavidu, Ramyasri Kodali
We rarely come across deficiency of niacin in the current clinical practice. Deficiency of niacin (Vitamin B3) leads to pellagra with constellation of symptoms affecting gut, skin, and nervous system. We present a case of nutritional deficiency of niacin presenting as pellagra in a 45-year-old female. The patient was treated successfully with Vitamin B3 supplementation. Pellagra shall be considered in differential diagnosis of chronic diarrhea when associated with skin lesions affecting sun-exposed areas.
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Pellagra p. 81
Viroj Wiwanitkit
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Rare cause for pneumothorax in a young male p. 83
M Vishnu Sharma
Pneumothorax can occur as a complication of underlying lung disease. Careful history, proper evaluation with sputum examination, chest radiology, and bronchoscopy will establish the cause for pneumothorax in most of the cases. Cystic lung diseases can cause pneumothorax in young individuals. High-resolution computed tomography scan of the thorax correlated with history and physical findings will establish the diagnosis in cystic lung disease. We discuss a rare cause for pneumothorax in a young male.
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Are all birds same? Looking beyond the purview of research methodology workshops p. 89
V Dinesh Kumar, M Shuriya Prabha
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Hand washing by health professionals-victim of a casual approach p. 90
Himadri Bal
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Failure to secure airway with awake fiberoptic bronchoscope-assisted intubation in a case of Cushing's syndrome p. 91
Vidhu Bhatnagar, Amit Rai, Vibhu P Raghuvanshi, Swayam Tara
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Critiquing the component of integrated teaching proposed under the new graduate medical regulations 2018 p. 93
Saurabh Rambiharilal Shrivastava, Prateek Saurabh Shrivastava
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