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   Table of Contents - Current issue
March-April 2019
Volume 12 | Issue 2
Page Nos. 95-185

Online since Monday, March 25, 2019

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Machine learning in medicine: Will doctors meet their waterloo? Highly accessed article p. 95
Amitav Banerjee
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Artificial intelligence in medicine: The way forward Highly accessed article p. 98
Pranay Goel
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The good old family doctor p. 100
Dilip Kanade
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Home visits and family physician p. 101
Vadisha Bhat
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Rare presentation of squamous cell carcinoma: A case report p. 103
Subhashish Das
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Fungal corneal ulcer: A prospective study on the causative fungus and the response to the present treatment protocol at ANIIMS, Andaman and Nicobar Islands-first time present p. 105
Sujit Das, H Sanjeev, Amit Banik
Background: Fungal keratitis accounts for 50% of all microbial keratitis, depending upon the geographic location. Filamentary fungi are predominant in tropical and subtropical climates. Treatment is given based on clinical diagnosis supported by the presence of fungus in potassium hydroxide (KOH) mounting, rather than on culture report because culture takes time. Reported studies from northern part of the country revealed Aspergillus as the most common fungus, whereas Fusarium was reported to be the most common fungus in southern part of the country. Aspergillus fumigatus is the most common fungus isolated in our study and the response to standard treatment is good. Aim of the Study: To identify spectrum of fungi, response to the standard treatment given, and sensitivity of KOH preparation in clinically diagnosed fungal corneal ulcers and to identify the predisposing factors and culture-positive cases (both Sabouraud's and blood culture). Methods: All patients who were clinically diagnosed to have fungal corneal ulcer, based on history, clinical features, and slit-lamp findings over a period of 1 year, were included in the study. All patients were subjected to corneal scraping and the material was examined by KOH mounting, Gram staining, and specific culture techniques. The ulcer was treated as per the standard treatment protocol followed in the institution, and the response to treatment was analyzed. Results: The study included 40 patients, with males being predominated (n = 36). KOH positivity was seen in 34 (85%) cases whereas KOH negativity was seen in 6 (15%) cases. Gram stain was positive in 6 (15%) cases. The culture was positive in all cases (100%). The most common fungus isolated was A. fumigatus – 24 (60%) cases. The response to the treatment after 8 weeks was found in 34 (85%) cases. Enucleation was done in 7 (17.5%) cases. Total therapeutic keratoplasty was done in 7 (17.5%) cases. Total penetrating keratoplasty was done in 4 (10%) cases. Conclusions: Rapid diagnosis and early institution of antifungal therapy are necessary to prevent ocular morbidity and blindness. Although culture helps in definite diagnosis and identification, direct microscopic detection of fungal structures in corneal scrapes permits a rapid presumptive diagnosis.
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Correlation and comparison of dactyloscopy and palatoscopy with blood groups among dental students from Western Maharashtra p. 111
Smriti Ramdas, Sushma Bommanavar, Rajendra Baad, Nupura Vibhute, Uzma Belgaumi, Vidya Kadashetti, Wasim Kamate
Background: Identification plays a major role in any crime investigation. Study of finger prints (Dactyloscopy) and palatal rugae patterns (Palatoscopy) have been recognized and accepted as gold standard for personal identification worldwide. Yet another biological record that remains timeless throughout the lifespan of a person is the blood group. Research works have been carried out on Dactyloscopy/Palatoscopy and blood groups independently. However, studies focusing on correlation and comparison of both these parameters have not been undertaken to a great extent. Aim: The aim of the present study is to correlate and compare Dactyloscopy and Palatoscopy with blood group among dental students from western Maharashtra population. Materials and Methods: A total of 200 dental students with age group ranging between 18-25 years with known blood group were included in the study. Finger print, Palatal rugae patterns were obtained and compared and the data was subjected to Excel sheet 2016 and Chi square test. Results: There was significant association between finger print patterns and ABO - Rh factors (χ2 statistic= 30.6, P value = < 0.05) and No correlation exists between palatal rugae patterns with blood groups and Rh factor (χ2 statistic= 17.71, P value = P > 0.05). Conclusion: Hence, the study concluded that finger prints rather than palatal rugae when correlated with suspect's specific blood group - Rh factor can be used to narrow down the suspect list and can also prove significant in identifying individuals in case of any disaster. Though the comparison of palatal rugae and finger print with blood group - Rh factor yielded no result.
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Client satisfaction and its correlates of directly observed treatment short course therapy in a tuberculosis unit of Bankura, West Bengal p. 116
Sumana Samanta, Aditya Prasad Sarkar, Dibakar Haldar, Asit Baran Saren, Gautam Narayan Sarkar, Indrajit Saha
Background: Tuberculosis (TB) is a curable disease still millions of people suffer and many of them die from this disease. Just providing anti-TB medication is not sufficient to ensure that patient to be cured. Objective: The objective of this study is to assess the treatment outcome rates and to find out the determinants of patient satisfaction. Materials and Methods: A clinic-based, descriptive, crosssectional study was conducted in Lokepur Tuberculosis unit (TU) from July 2015 to June 2016. Simple random sampling was adopted to select 50% of the Directly Observed Treatment Short Course (DOTS) centers under that TU. Afterward, complete enumeration of the adult TB patients receiving Category I treatment and registered from June to October 2015 was done from the selected DOTS centers. Exit interview of the patients was conducted using pretested predesigned questionnaire and treatment outcomes were recorded from TB register. Data were entered in MS Excel Spreadsheet and analyzed by SPSS 22.0 version. Results: Treatment success rate of Category I TB patients was about 87%. Almost 76% patients were satisfied with the given services. Treatment success rate was higher among the satisfied (97%) than the not satisfied (57%) clients and the difference was statistically significant. Client satisfaction was statistically associated with gender, residence, educational level, first caregiving person, and decision maker in getting treatment. Conclusion: Concern given to urban slum areas, improvement of literacy status of the patients, arrangement of the alternative sources of income for TB-affected family, and improvement of the knowledge of first caregiving persons are the steps to be taken at this hour.
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Anorectal malformations: Early outcome analysis from a high-volume tertiary care institute p. 122
Rahul Gupta, Arun Kumar Gupta, Arvind Kumar Shukla, Vinita Chaturvedi, Pramila Sharma, Ramesh Tanger
Context: Associated malformations in anorectal malformation (ARM) are of important implication with regard to final outcomes since the anorectal lesions that cause intestinal obstruction are correctable with operative intervention. Aims: To study the presentation, types of anomalies, associated malformations, and procedures performed in relation to the type of anomaly and early outcomes analysis of ARM patients in the neonatal period. Settings and Design: A retrospective study was performed from January 2016 to December 2016. Subjects and Methods: The study included all patients with ARM admitted in the Neonatal Intensive Care Unit. Results: There were 216 neonates having ARM with 173 males and 43 females (m:f = 4:1). High-type ARM was seen in 177 (81.94%) cases, while low type in 39 (18.06%) neonates. Associated malformations were documented in 67 (31.02%) neonates. Esophageal atresia (EA) was the most common (51) associated anomaly. Among the 200 procedures undertaken for ARM, left transverse loop colostomy was the most common (132). Only 83 (38.42%) neonates were diagnosed on the 1st day of life. There were 67 (31.02%) deaths, 145 (67.13%) survivors, and 4 (1.85%) cases left against medical advice. There were only 9 (17.65%) survivors among those associated with EA. Cardiovascular was the most common (39) cause of mortality followed by septicemia (30). Conclusions: An overall high mortality rate of 31.02% and an extremely high rate (74.51%) among those associated with EA were present. In spite of the progress made in the field of neonatal care, associated malformations compounded with a high volume of patients in our resource-limited institution negatively influence the outcome of ARM in the newborn period. Strict infection control measures for prevention of septicemia and investigations for other associated malformations are recommended to improve the outcomes.
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Prospective randomized comparative trial of dexmedetomidine versus esmolol for attenuation of extubation response p. 131
Nirav Kotak, Rahul Mamde, Pushkar M Desai
Background and Aims: General anesthesia is known to elicit stress response during endotracheal intubation, but the equally important period of extubation is usually not addressed. The aim was to compare dexmedetomidine and esmolol for attenuation of extubation response. Materials and Methods: In this prospective randomized double-blind trial, 100 American Society of Anesthesiologists I/II patients between 18 and 60 years of age undergoing abdominal and lower-limb surgeries were randomly allocated into two groups (n = 50 each). Patients in Group D received dexmedetomidine (0.5 μg/kg intravenous [IV] bolus) over 10 min and in Group E received esmolol (1 mg/kg bolus IV) before extubation. Hemodynamic parameters, namely, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were compared at baseline, 10 min before extubation, at extubation, and at 1, 3, 5, 10, and 15 min thereafter. Data were expressed as mean ± standard deviation and analyzed using Student's unpaired t-test and Chi-square test. P <0.05 was considered statistically significant. Results: Patients in Group D exhibited lower HR, SBP, DBP, and MAP at the time of extubation till 15 min postextubation (P < 0.001) although the difference was clinically insignificant. Incidence of hypotension was similar in both groups (6% vs. 4%). Two patients in Group D developed bradycardia which was successfully treated with injection glycopyrrolate, while none exhibited any complication in Group E. Conclusion: Dexmedetomidine is a better, effective, and safe alternative to esmolol in attenuating stress response during extubation.
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Awareness regarding pre-conception and pre-natal diagnostic techniques act among women in a rural community of Puducherry p. 136
Pamagal Kavithai, R Anandaraj, K Puhalenthi
Context: Child sex ratio of the nation has been declining since few decades. Aims: The objectives of this study are to find out awareness about Pre-conception and Pre-natal Diagnostic Techniques (PC-PNDT) act among ever-married women and to determine their sociodemographic factors influencing this awareness. Settings and Designs: This was a cross-sectional study conducted at a rural primary health center of Puducherry. Subjects and Methods: A cross-sectional study was conducted at a rural primary health center in Puducherry among 200 ever-married women in reproductive age group. Information regarding their awareness about PC-PNDT Act was collected using a semi-structured questionnaire. Statistical Analysis Used: Chi square-test was done for analyzing the categorical data. Results: Among the ever-married women, about 30 (15%) were not aware about the provisions of PC-PNDT Act, while 170 (85%) were aware about it. No significant association was found between sociodemographic variables and awareness about the Act. Conclusions: Majority of the ever-married women in the study setting were aware of the provisions of PC-PNDT Act.
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Study of efficacy and functionality of modified technique of proximal arteriovenous fistula as a vascular access for hemodialysis: A retrospective analysis of 171 cases p. 139
Parag Sahasrabudhe, Tushar Anil Dighe, Neeranjan Ambekar, Nikhil Panse, Shraddha Deshpande, Sheetal Londhe, Jesal Rathod, Mugdha Pradhan, Mogal Vajed
Background: Vascular access is the lifeline for a patient on hemodialysis. An arteriovenous fistula is the gold standard for hemodialysis access. The order of preference as given by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative guidelines suggests radiocephalic, brachiocephalic, and brachiobasilic transposition fistulae and then prosthetic grafts as vascular access options. Brachiobasilic transposition fistulae are associated with multiple challenges and complications. By our modified technique of brachiobasilic fistula, we have overcome the challenges posed by the conventional technique. In this study, we have evaluated the results of our modified technique and compared them with conventional technique. Materials and Methods: A retrospective analysis was done, in which all cases of proximal fistula for hemodialysis performed in our institute by the modified technique from January 2010 to December 2014 were included in the study. Result: Of the 171 patients, 136 (79.5%) were successful. The primary failure rate was 20.5%. Maturation time required for the fistula to develop was 46.7 (±4.17) days. Flow rates of more than 250 ml/min could be maintained in 58.8% of patients. Patency rates were 79% at the end of 1st year, 74.2% at the end of 2nd year, 45.7% at the end of 3rd year, and 40.2% at the end of 5th year. Ease of access was determined by a number of pricks required to gain access and development of forearm veins. Of the 136 successful cases, 110 (80%) could be cannulated with ease in the first prick itself. Access over forearm was possible in 117 (86.1%) cases. Conclusion: The modified technique of brachiobasilic fistula overcomes the risk of complications and morbidity of conventional brachiobasilic transposition fistula and is equally effective as vascular access.
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Study of cervical papanicolaou smear in intrauterine contraceptive device users in a tertiary care hospital p. 145
Nirvana Rasaily Halder, Babai Halder, Yalavarthi Sushma
Background: The use of intrauterine contraceptive device (IUCD) generally has been known to be safe and effective but tends to have some side effects. Reproductive tract infection is one of the major complications caused by prolonged usage of an IUCD. Cervical smears have shown an increase in inflammation, inflammatory epithelial changes, or metaplastic cells among the IUCD users as compared to nonusers. There is also a predisposition to higher rate of infections such as Actinomyces, atypical squamous cells of undetermined significance, and low-grade squamous intraepithelial lesion. Aims and Objectives: The aim of this study was to study changes in cervical cytology in IUCD users and to assess the risk of epithelial cell abnormalities among IUCD users compared to nonusers. Materials and Methods: A 2-year cross-sectional study was carried out to screen Papanicolaou (Pap) smears in women of the reproductive age group who were categorized as IUCD and non-IUCD users. Results and Observations: A total of 1100 (550 + 550) Pap smears from IUCD and non-IUCD users were analyzed. Among IUCD users, 544 cases (98.90%) were adequate for reporting including 533 cases (97.98%) showing negative for intraepithelial lesion or malignancy (NILM) and 11 cases (2.02%) showing epithelial cell abnormality (ECA). In non-IUCD users, 541 cases (98.36%) were adequate for reporting. Among these, 538 cases (99.44%) showed NILM and 3 cases (0.56%) showed ECA. Conclusion: In IUCD users, the prevalence of infections and ECA is higher than non-IUCD users.
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Intrauterine contraceptive device and the cervicovaginal smear – Exploring the enigma p. 150
HL Kishan Prasad
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An unusual color change in tetracycline HCl powder – from drug to poison p. 152
Chukwuebuka Egbuna
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Skeletal tuberculosis leading to pathological fracture p. 155
Lavina Vijay Desai, Ira Shah
Skeletal tuberculosis (TB) is usually present in 1%–3% of active TB patients. Those with altered immunity have an increased of Skeletal TB. The most commonly involved sites are hip (20%), knee (10%), ankle and foot (5%), and shoulder (1%), and the most common forms of presentation are arthritis, spondylitis, and osteomyelitis. Tuberculous pathological fracture is a rare presentation, and only three cases have been reported in literature. We present a case of a 4½-month-old boy with a nontraumatic fracture of the humerus secondary to TB. Our patient was started on a four-drug regimen consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide and advised immunodeficiency workup.
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Vaginal foreign body in a child: Sexual abuse or sibling prank? p. 157
Rahul Gupta, Badri Lal Patidar
Vaginal foreign body is a rare condition. We present a 6-year-old girl who had dysuria and itching in the perineum; examination revealed a vaginal foreign body which was a broken safety pin. Radiographs after its removal revealed a pin of the safety pin left in the vagina which was later removed under anesthesia. A high index of suspicion for a vaginal foreign body should be present while evaluating a child with genitourinary complaints. Vaginal foreign body in children may be an indicator of possible sexual abuse; although in the present case, it was a prank by her elder sibling. Importance of postprocedural radiographs has been emphasized after removal as multiple/broken pieces may be present, which may not have been visualized initially. Evaluation for concurrent sexually transmitted diseases is paramount if sexual abuse is suspected.
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Duodenal duplication in an infant p. 160
Aditya Pratap Singh, Arun Kumar Gupta, Ranjana Solanki, Maryem Ansari
Bilious vomiting is a relevant sign in children that requires immediate evaluation and diagnosis. One of the causes is an obstruction of the intestinal tract due to duplication if located distal to the major duodenal papilla of Vater. Most of the duplications involve the jejunum, stomach, and colon. Duodenal duplications are very rare and can have an endoscopic or surgical treatment after diagnosis. We are reporting here a case of duodenal duplication in a 3-month-old male child who presented to us with bilious vomiting. Most of them are associated with other anomalies. Completely isolated duodenal duplication is very rare. Therefore, we tried to review the topic while presenting this rare case report of isolated duodenal duplication cyst.
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Situs inversus totalis associated with cancer: Report of three rare cases and review of literature p. 164
Rajendra Kumar Tanwar, Rajshree Bhati, Nilima Soni, Suresh Dangayach Kumar, Bharti Saxena
Situs inversus totalis (SIT) is rare congenital recessively inherited condition in which there occurs transposition of all viscera in a mirror image form. The relationship between SIT and neoplasia is still unclear. We hereby report three rare cases (carcinoma esophagus, carcinoma lung, and non-Hodgkin lymphoma thyroid) associated with SIT. We report the first case in world literature of primary esophageal carcinoma associated with HIV and SIT.
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Situs inversus totalis associated with cancer: Report of 3 rare cases and review of literature p. 169
Subhashish Das
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Reattachment of anterior teeth fragments – An unconventional treatment option to regain what is lost: Report of two cases p. 170
Vishnu Pratap Singh Rathore, Karkala Venkappa Kishan, Dexter Brave, Margi Sandip Kumar Parikh
Anterior crown fractures are a common form of traumatic dental injuries that mainly affect the maxillary incisors especially in children and adolescents. Complicated crown fractures although less common can be a challenging task to the clinician. Since the development of adhesive dentistry, the patient's own broken tooth fragment can be used to restore the fractured tooth. Reattachment of fractured tooth fragments with fiber postreinforcement offers a viable restorative alternative. Such procedure is economical and needs less chair-side time as compared to many traditional methods. In addition, the procedure provides good and long-lasting esthetics, as the original morphology, color, and surface texture are preserved. The main objective while treating such cases is successful pain management and immediate restoration of function, esthetics and phonetics. This paper presents a report of two cases of coronal tooth fracture that is successfully managed using tooth fragment reattachment.
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Incidental detection of chorangioma with chorangiosis of placenta: A rare case report p. 174
Yamini Pradeep Ingale, Archana Chirag Buch, Piyusha Naragude Ulhas, Harsh Kumar
Chorangioma of the placenta is a rare tumor with a frequency of about 1%, which usually presents as a solitary nodule or, less frequently, as multiple nodules. It is benign vascular tumors of the placenta arising from chorionic tissue. Large chorangioma has adverse effects on both mother and fetus. Chorangiosis is characterized by an increase in number of small-sized vascular channel within chorionic villi. Chorangiosis is considered as a hypoxia-related angiogenesis mainly associated with numerous maternal, fetal, and placental disorders. The case presented to highlight incidental detection of this rare tumor of large size without causing any pregnancy disorders or developmental anomalies of the fetus in a young female.
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Retroperitoneal spindle cell variant of embryonal rhabdomyosarcoma in a child p. 177
Aditya Pratap Singh, Arun Kumar Gupta, Arpita Jindal, Kalpana Mangal
Spindle cell rhabdomyosarcoma (RMS) is a rare variant of embryonal RMS that has a predilection for young males and most commonly involves the paratesticular region followed by the head and neck. Histopathology reveals elongated spindle cells with fusiform to cigar-shaped nuclei and indistinct eosinophilic cytoplasm arranged in fascicles or whorls. Immunohistochemical workup demonstrates sarcomeric differentiation with reactivity for desmin, myogenin, and MyoD1 markers. Compared with other subtypes, the spindle cell variant in children is associated with a favorable outcome; however, in the adult population, there does not appear to be any prognostic advantage. We are presenting here a case of an embryonal variant of the spindle cell RMS in a 30-month-old male child.
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Isolated epileptic nystagmus p. 180
Shalesh Rohatgi, Satish P Nirhale, Pravin Naphade, Prajwal Rao, Khadkikar Gajanan
Isolated epileptic nystagmus is defined as a quick, repetitive jerky movement of the eyeball associated with seizure activity on electroencephalography. However, there are no clinical seizures apart from nystagmus. We report a case of 56-year-old male, not a known case of diabetes or hypertension, nonsmoker, who presented with frequent episodes of dizziness along with difficulty in reading in that the lines in newspapers were moving side to side. He was conscious during episodes. He was found to have episodes of gaze deviation to the left with left beating nystagmus lasting for about 30 s. Routine hematological and biochemical parameters were normal. Electroencephalogram showed right parieto-temporo-occipital epileptogenic activity. Magnetic resonance imaging (MRI) brain showed diffusion restriction in the right temporo-occipital region suggestive of small ischemic infarct. Repeat MRI after 1 month was normal. He responded to levetiracetam.
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Rosmarinic acid and the most important effects of it on bacteria and signaling pathways of cell p. 183
Seyed Hossein Shahcheraghi, Jamshid Ayatollahi, Marzieh Lotfi, Faeze Sadat Heidari, Sudabe Hemati
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Constraint-induced movement therapy is a potential treatment for improving upper limb function in stroke patients p. 184
Shalesh Rohatgi
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Travails of the english language in scientific writing p. 185
Himadri Bal
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