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   2018| July-August  | Volume 11 | Issue 4  
    Online since August 2, 2018

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Platelet-Rich fibrin: A “wonder material” in advanced surgical dentistry
Nikunj Maniyar, Gargi S Sarode, Sachin C Sarode, Jahanvi Shah
July-August 2018, 11(4):287-290
One of the promising innovations in the field of surgical dentistry is the use of platelet-rich fibrin (PRF), alone or as an additive with other biomaterials. It accelerates the healing mechanism of the tissue and reduces the inflammation. The following article summarizes the role of PRF in the process of healing, its advantages, disadvantages, and clinical implications including advanced surgical dentistry.
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Dietary diversity and its determinants: A community-based study among adult population of Durgapur, West Bengal
Archan Mukherjee, Sourabh Paul, Indranil Saha, Tapas Kumar Som, Gautam Ghose
July-August 2018, 11(4):296-301
Introduction: Proper diet is essential from the very early stages of life for proper growth and development. Increasing the variety of foods and food groups in the diet helps to ensure adequate intake of essential nutrients. The study was conducted with the objective to assess the dietary diversity pattern and to find the association between dietary diversity score and selected sociodemographic variables among adult population, if any. Materials and Methods: A community-based cross-sectional study was conducted between December 2016 and January 2017 among 216 adults with the help of dietary diversity questionnaire from rural and urban field practice area of the Department of Community Medicine, IQ City Medical College, Durgapur, West Bengal, India. Pearson's Chi-square test, Mann–Whitney U-test, and binary multivariable logistic regression analysis were performed using SPSS software. Results: The median dietary diversity score of the participants was 6. Nearly 45.4% of participants had adequate dietary diversity scores. Most common food groups consumed by the participants were starchy staples (100%), followed by oil and oil-based items (99.5%) and milk and milk products (86.1%). Age, residency, type of family, and occupation have a significant association with adequate dietary diversity. Conclusion: Awareness program on dietary diversity should be organized to make people aware about the importance of dietary diversity. Proper diet is essential from the very early stages of life for proper growth and development. Increasing the variety of foods and food groups in the diet helps to ensure adequate intake of essential nutrients.
  2,696 432 -
Patient satisfaction at a primary level health-care facility in a district of West Bengal: Are our patients really satisfied?
Abantika Bhattacharya, Sita Chatterjee, Abhishek De, Somak Majumder, Kanti Bhusan Chowdhury, Mausumi Basu
July-August 2018, 11(4):326-331
Introduction: Many recent studies have shown an increased association between patient's satisfaction levels, patient's compliance, and success of treatment. Aim: The aim of this study is to assess the level of satisfaction among patients who have utilized the outpatient department services provided in the primary care level health institution. Materials and Methods: A health center-based observational cross-sectional study was conducted from July 2011 to October 2011 at Guskara Primary health center, Burdwan among 422 patients using a pre-designed pre-tested structured schedule. Results: Overall, mean satisfaction score was 2.97 ± 0.37. Highest satisfaction scores were observed among 18–20 years, males were more satisfied regarding technical quality of care, whereas females reported higher satisfaction regarding interpersonal manner, unmarried/single group reported the highest satisfaction with most of the services, literate group reported higher satisfaction than the illiterate group, affluent patients reported higher satisfaction regarding technical quality of care, financial aspect. Conclusions: Causes of dissatisfaction were long waiting time, the inadequacy of seating arrangement in the waiting area, inadequate cleanliness of surroundings, inadequate toilet facilities, nonavailability of medicines, and behavior of doctor.
  2,101 247 -
To wear or not to wear: Is it time to return the borrowed white coat?
Amitav Banerjee
July-August 2018, 11(4):285-286
  2,113 234 -
Squamous cell carcinoma of clitoris
Nilima Soni, Bharti Saxena, RK Tanwar, Vandana Pathak
July-August 2018, 11(4):357-359
Carcinoma of Clitoris is very rare and is important because of its aggressive nature and clinical course leading to early death. Cancer of vulva accounts to 4 % of all malignancies of female genital tract and 0.6% of all cancers in women. The case of a 68 year old female who presented to gynaecology outdoor with a clitoral growth involving adjacent vulva. CT scan showed involvement of clitoris, labia majora and inguinal lymph nodes. FNAC from the lesion followed by Biopsy proved a case of well - differentiated squamous cell carcinoma. Management of such case is a challenge for the surgical oncologist, due to advanced stage at presentation. Hence, such lesions require early biopsy to avoid delay in diagnosis and further management of the case.
  1,965 82 -
Polycystic ovarian syndrome leading to ovarian torsion in a 19-year-old
Savita Rani Singhal, Kriti Agarwal, Krishna Dahiya, Reetu Hooda
July-August 2018, 11(4):360-362
Ovarian torsion (OT) is the fifth most common gynecological emergency with a reported prevalence of 2.5%–7.4%. A 19-year-old unmarried girl, known the case of the polycystic ovarian syndrome (PCOS) was referred with sudden onset left-sided lower abdominal pain for the past 7 days, associated with vomiting. On examination, lower abdominal tenderness, exclusively to the left side was present. Ultrasound showed a bulky left ovary of 6 cm × 8 cm × 6 cm with no vascularity and fluid in POD. Laparoscopy revealed a gangrenous left ovarian cyst of 8 cm × 8 cm, twisted five times over the fallopian tube which was adherent to lateral pelvic wall and omentum. Left oophorectomy was done. In all patients of PCOS with acute abdomen, ovarian torsion should be included in differential diagnosis, and early recourse to laparoscopy is the key for prevention of the dreaded complication of the gangrenous ovary and ultimately oophorectomy.
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A rare case of xanthogranulomatous mastitis with intraductal papilloma
Sunita Arvind Bamanikar, Shirish S Chandanwale, Pooja Pathak, Anushree Gambhir, Jay Sheth
July-August 2018, 11(4):348-351
Xanthogranulomatous inflammation is rare and has been described most commonly in kidney and gallbladder. It is extremely rare in breast. We report here a case of a 42-year-old female who came with firm painless lump in the left breast. Mammography suggested suspicious neoplastic retroareolar lesion. Fine-needle aspiration (FNA) smears suggested a benign cystic lesion and excision of the cyst was advised. Histopathological examination revealed breast tissue infiltrated with polymorphonuclear leukocytes, lymphoplasmacytic inflammatory cells, few giant cells, and sheets of foamy histiocytes (xanthoma cells) with a focus of intraductal papilloma. A diagnosis of xanthogranulomatous mastitis with intraductal papilloma was made. Chronic inflammatory lesions are known to produce firm lesions which may mimic neoplastic lesion. Definitive diagnosis could not be achieved in FNA smears due to the absence of adequate number of xanthoma cells. Final diagnosis was made on histopathology examination. Xanthogranulomatous mastitis is an extremely rare entity. Clinical presentation is quite variable. Imaging modalities and FNA are inadequate for definitive diagnosis.
  1,728 98 -
Psychiatric emergency referrals in a tertiary care hospital
Gagandeep Singh, Suprakash Chaudhury, Daniel Saldanha, Vasdev Singh, Shivaji Marella, Rajeshwari Vhora
July-August 2018, 11(4):312-317
Background: Acute psychiatric emergencies such as excitement, violence, stupor, and suicidal attempts, previously the domain of mental hospitals, are now handled by the general hospital psychiatric units. There is a paucity of Indian data concerning psychiatric emergency referrals. Aim: The aim is to study psychiatric emergency referrals in a teaching hospital. Materials and Methods: This hospital-based, descriptive study was undertaken in Emergency Medicine and Psychiatry Departments of a tertiary care hospital during the period of November 2016 to April 2017. All patients were first evaluated by the postgraduate resident on duty of Emergency Medicine Department and triaged using mental health triage scale (MHTS). The total sample size was 60. Sociodemographic particulars of patients and reason of referral were recorded on a special proforma, and the Brief Psychiatric Rating Scale (BPRS) was administered. Psychiatric diagnoses were made according to the International Classification of Disease, 10th Revision Diagnostic Criteria for Research. Results: Out of total 60 patients, 70% were males and 30% female. Most of the patients (41.7%) belonged to the age group of 31–40 years and 53.3% were married. Majority (61%) were referred by family members while 25% were referred by a nonpsychiatric medical professional. The most common reason for psychiatric referral was the presence of coexisting mental symptoms along with physical illness (38%) while 25% were referred as they had predominant psychiatric symptoms. The most common triage category was yellow (38%) and the least common was red category. Schizophrenia (33.3%) was the most common psychiatric diagnosis, followed by alcohol dependence (25%) and mania (16.7%). There was a significant correlation of BPRS score to severity according to triage. Conclusions: The common psychiatric disorders seen in Emergency Department (ED) are schizophrenia, substance use disorder, and mania. MHTS can be easily used by ED doctors for quick and appropriate triage of patients with psychiatric symptoms.
  1,592 129 -
Relationship between dominant hand and ear preference for listening among medical students
Sandeep Sachdeva, Nidhi Dwivedi
July-August 2018, 11(4):307-311
Objective: The aim of the study was to determine dominant hand for routine activities and ear preference for listening among medical students. Mobile phone usage was also studied. Methodology: Medical students of three batches (2nd, 3rd, and 4th year) studying in a government medical college of Delhi (India) were considered. Out of 150 permitted (50 per batch) seats, only 139 were filled. Thus, after seeking an informed consent, a total of 117 (84.1%) available students could be contacted in person who completed the survey capturing details such as Section-I: Sociodemographic background; Section-II: Dominant hand (right/left) for undertaking routine activities, ear (right/left) preference for listening say mobile phones; and Section-III: Selected details of their mobile phones. Results: There were 71 (60.7%) males and 46 (39.3%) female students; It was found out that out of 117 students, 110 (94.0%) were right handed while 7 (5.9%) were left handed. Out of all the right-handed persons (n = 110), 94 (85.4%) preferred right ear, 14 (12.7%) left ear, and 2 (1.8%) either of the ears for listening phone. Similarly, out of all the left-handed persons (n = 07), 6 (85.7%) preferred left ear and only 1 (14.2%) right ear for listening mobile phone. Right-sided (right hand-right ear) laterality was observed in 85.4% and left-sided (left hand-left ear) laterality in 85.7% with overall (same hand-same ear) laterality of 85.4% among study participants (P < 0.01). Most common color of mobile phone was black (59, 50.4%), white (30, 25.6%), golden (13, 11.1%), silver (6, 5.1%), etc. Average time spent per day by medical students on mobile phones (either communication, Internet/WhatsApp/Facebook, listening songs, playing games, or reading E-books) was 3.83 (±2.1) h and average monthly expenditure on mobile phone was 10% of personal expenditure, i.e., Rs. 532 (±374.4). Conclusion: Our descriptive study reiterates that most participants were right handed (dominant limb) and majority of them preferred right ear for listening phones.
  1,331 115 -
How to conduct medical viva
Vishnu Sharma Moleyar
July-August 2018, 11(4):374-378
Medical viva is oral form of assessment of medical students. Viva helps to assess the competencies such as communication skills and professional attitudes which are essential to a medical graduate. Viva test delineates the limit of a candidate's knowledge and understanding of a particular subject/topic being tested. Viva should be conducted fairly, should be reliable, and free from any form of bias. Structured viva examination is better and more realistic to fulfill these criteria than traditional viva examination. Viva can be structured using viva cards. Trained and experienced examiners are a must for the proper conduct of viva.
  1,289 149 -
Teething myths among health workers in a tertiary health facility
Ibrahim Aliyu, Igoche David Peter, Shakur Abubakar, Mustafa O Asani, Godpower C Michael, Abdulazeez O Ahmed, Ismail Mohammed Inuwa, Nasir Ishaq, Suleiman Dada Aliyu
July-August 2018, 11(4):291-295
Background: The teething process is part of normal development of the skeletal system; however, different tribes and ethnic groups seem to have a list of symptoms they believe are linked to teething. Could it be that health professionals also hold to these false believes concerning teething? This is important to find out because when systemic problem is misdiagnosed as teething and nothing is done, it may result in death. This study aims to assess the level of knowledge of infants' teething and associated myths among health professionals, to ascertain the attitude of health professionals toward teething in infants, and to identify practices by health professional toward “teething problems.” Materials and Methods: This study was cross-sectional study, conducted from August to September 2016, and multistage sampling method was adopted. Results: Four hundred and fifty health workers participated in the study; however, 427 of them correctly completed the questionnaire giving a response rate of 94.9%. There were 213 (49.9%) males and 214 (50.1%) females with m:f ratio of 1:1. Most respondents (322; 77.8%) believed teething was associated with significant systemic symptoms, 92 (21.5%) did not associate teething with any significant systemic complaint, while only 3 (0.7%) of them were not sure if teething causes systemic illness. Fever and loss of appetite were the most common symptoms associated with teething followed by stooling while skin rash was the least common complaint associated with teething. Conclusion: Teething myths are still prevalent among health-care workers; common illnesses attributed to teething included fever, loss of appetite, excessive salivation, and diarrhea.
  1,222 139 -
Idiopathic lymphocytic interstitial pneumonia
Chinnu Sasikumar, Ketaki Utpat, Jyotsna M Joshi
July-August 2018, 11(4):363-365
Lymphocytic interstitial pneumonia (LIP) is one of the rare interstitial lung diseases exhibiting a profuse infiltration of lymphoid cells in the interstitium of the lung. It has been classified as one of the rare idiopathic interstitial pneumonias (IIPs) as per the recent American Thoracic Society/European Respiratory Society classification of IIPs. It is an uncommon entity in itself with the idiopathic variety being prodigiously singular. Diagnosis is accomplished by collaboration of clinicoradiological and histopathological attributes. Corticosteroids form the mainstay of therapy with a protean response to therapy. We hereby report a distinctive case of idiopathic LIP picked up inadvertently during a preoperative evaluation.
  1,174 94 -
Tubulocystic renal cell carcinoma: An entity related to papillary renal cell carcinoma?
KR Anila, Anitha Mathews, Paul Augustine, E Krithika, K Jayasree
July-August 2018, 11(4):332-334
A 48-year-old man presented to our surgical oncology division with incidentally detected abdominal mass. On examination, a ballotable swelling was present in the right lumbar region. His imaging studies showed a large multicystic mass in the lower pole of the right kidney. With radiological diagnosis of cystic renal cell carcinoma (RCC), the patient was taken up for surgery. Histopathology showed tubulocystic RCC (TC-RCC) with a focus of papillary RCC. Though closely related to papillary RCC, TC-RCCs of kidney are a distinct group of RCC. Analysis of more cases is required to understand the exact tumor biology and to ascertain prognosis.
  1,128 83 -
Comparison of different sizes Airtraq™ optical laryngoscope in pediatric patients: A prospective, observational study
Ketan Sakharam Kulkarni, Nandini M Dave, Priyanka P Karnik, Madhu B Garasia
July-August 2018, 11(4):302-306
Background: We aimed at comparing the performance of the three different sizes of AirtraqTM, when performing tracheal intubation in paediatric patients requiring general anaesthesia with endotracheal intubation. Methods: After obtaining informed count from parents, 30 infant, 30 children and 30 adolescent patients underwent tracheal intubation in K.E.M. hospital using AirtraqTM laryngoscope. All patients were intubated by an anaesthetist having at least 5 years of experience in anaesthesia. Results: The Small Airtraq performed best, with less time taken for intubation, no failed intubations, grater percentage of glottic opening score and visual analogue score for ease of use. Optimization manoeuvres were required for intubations in all the patients in infant group; with 5 failed intubations indicating intubation using infant Airtraq was more challenging. Conclusions: Proficiency in using Airtraq in adults may not always translate to successful intubations in infants. Learning curve of an airway gadget is witnessed in its different sized version.
  1,078 105 -
Acute fulminant necrotizing amoebic pancolitis: A lethal entity in children
Rahul Gupta, Shahida Riyaz, Nilima Soni
July-August 2018, 11(4):338-341
A 4-year-old boy presented in a state of septicemic shock, disoriented with peritonitis, and marked hemodynamic instability. The child was resuscitated; radiographs confirmed pneumoperitoneum. Intraoperatively, there were multiple perforations with necrotic changes in the entire colon up to the rectum, suggestive of acute fulminant necrotizing pancolitis. He was managed by total colectomy, ileostomy, with Hartman's pouch. Histopathology confirmed necrotizing amoebic pancolitis. Postoperatively, administration of metronidazole with broad-spectrum antibiotic coverage, hyperalimentation, and multiple platelet concentrates was given. The child had profound immunosuppression and expired due to multiple organ dysfunction syndrome. Acute fulminant necrotizing amoebic pancolitis is an extremely lethal entity in children.
  999 83 1
Traumatic optic neuropathy: Surgical intervention improves vision and color perception
Sujit Das
July-August 2018, 11(4):366-370
The most common cause of traumatic optic neuropathy (TON) is indirect injury to the optic nerve, which is thought to be the result of transmitted shock from an orbital impact to the intracanalicular portion of optic nerve. Direct TON can result from penetrating injury or from bony fragments in the optic canal or orbit piercing the optic nerve. Orbital hemorrhage and optic nerve sheath hematoma can also cause TON by direct compression. There may be optic nerve avulsion and transection also. Trauma to the optic nerve rarely improves vision with best of the management. The diagnosis of TON is made clinically based on history and ophthalmic signs along with neurological investigations. The management of indirect optic nerve injury is controversial. Experimental studies of optic nerve injury have employed Corticosteroid Randomization After Significant Head injury study, National Acute Spinal Cord Injury Study (NASCIS 2 and 3) and optic canal depression surgery. Most of the therapeutic regimens have been extrapolated from the NASCIS II, which showed a statistically significant improvement in neurologic outcome (motor and sensory) in a subgroup analysis of acute spinal cord injury patients receiving a methylprednisolone 30 mg/kg bolus within 8 h of injury, followed by 5.4 mg/kg/h for 23 h, but sometimes have high death rates and other complications. Based on the studies, good results can be obtained if interventions are made within 8 h of incident and observation thereafter.
  983 97 -
Late solitary pancreatic metastasis from renal cell carcinoma diagnosed on endoscopic ultrasound-guided fine-needle aspiration biopsy: A rare case report
Abhijeet Ingle, Vijaya Gattu, Ravishanker Reddy, Abdul Khaliq, Vamshi Krishna Reddy
July-August 2018, 11(4):335-337
Metastasis of renal cell carcinoma to the pancreas is a rare neoplasm accounting for 0.25%–3% of all pancreatic tumors and most cases arise from renal cell carcinoma. Symptomatic patients usually present with obstructive jaundice, abdominal pain, or gastrointestinal (GI) bleeding . The diagnosis usually occurs in asymptomatic patients during follow-up for renal cell carcinoma. It usually befalls slowly from 2 to 18 years after the onset of the primary tumor of the kidney. We report a case of a 58-year-old male patient who presented to the hospital with weight loss, anorexia, and elevated blood glucose and found to have a large tumor in the head of the pancreas, diagnosed on contrast-enhanced computed tomography. Patient underwent left radical nephrectomy 10 years ago for renal cell carcinoma.
  940 70 -
Tubercular scleritis: A rare presentation
Sujit Das
July-August 2018, 11(4):344-347
Tubercular scleritis is a rare condition and the sclera may be involved by direct spread from the adjacent ocular structures or more commonly by hematogenous spread as a secondary involvement. The present case of sputum-positive pulmonary tuberculosis (TB) with diabetes presented with features of anterior scleritis, anterior uveitis, and peripheral vasculitis and was well managed with antitubercular therapy, systemic analgesic (indomethacin), systemic short course of corticosteroid, and antidiabetic drugs. Systemic steroid is always reserved for patients with severe scleritis/necrotizing scleritis, and it was a challenge for us to start systemic steroid in a patient with sputum-positive pulmonary TB.
  931 77 -
Assessment of factors associated with drainage duration and hospital stay of nontuberculous empyema in a tertiary care hospital of West Bengal: A prospective study
Santanu Ghosh, Aditya Prasad Sarkar, Suvendu Pal, Rabindra Nath Roy
July-August 2018, 11(4):318-323
Context: Empyema thoracis is a common cause of morbidity and mortality. A number of factors could affect the treatment outcome of empyema cases. Aims: To assess the clinical and microbiological characteristics of non-tuberculous empyema and the factors associated with duration of chest drainage and hospital stay. Settings and Design: The Department of Pulmonary Medicine of a teaching institution in eastern India. A prospective observational study. Material and Methods: The study was conducted among the admitted non tuberculous empyema cases over the period of 18 months. The demographic profile, clinical features, duration of chest drainage and hospital stay of 80 cases who were admitted during the data collection period was recorded. Statistical analysis used: Data were analysed using unpaired t test, Bivariate Correlation, Chi square test and Fisher's exact test with the help of SPSS 22.0 software. Results: Majority of cases were male and from rural area. Mean duration of intercostal chest tube drainage and hospital stay were 16 ± SD 5.2 and 17.7 ± SD 5.1 days respectively which were significantly increased with prolongation of interval between symptom onset and chest drain insertion (P = 0.000 and P= 0.000) and in presence of comorbidity (P = 0.022 and P= 0.026), pleural fluid loculations (P = 0.015 and P= 0.029), positive culture growth (P= 0.012 and P= 0.021) and presence of gram negative organism (P =0.005 and P = 0.008) in pleural fluid. Conclusions: Chest drain duration and hospital stay could be used as surrogate indicators for treatment outcome measures.
  893 76 -
Blunt trauma abdomen-induced jejunal perforation with appendicitis
Aditya Pratap Singh, Arun Kumar Gupta, Rajlaxmi Pardeshi, Dinesh Kumar Barolia
July-August 2018, 11(4):371-373
  900 66 -
Living in the sub-sahara with anhidrotic ectodermal dysplasia: Report of two cases
Ibrahim Aliyu
July-August 2018, 11(4):352-354
Ectodermal dysplasia occurs worldwide. It is a hereditary disorder, and there are predominately two forms as follows: X-linked anhidrotic form and an autosomal dominant hidrotic form. It is mainly characterized by defects of the hairs which are sparse, nail defects, dental abnormalities, and the presence or absence of the eccrine glands. However, our cases had an abnormality of all four ectodermal structures. While they refused dental prosthesis, their major complaint had been heat intolerance which is a big treatment challenge in a hot climate as experienced in Kano Nigeria.
  859 71 -
Spotlight initiative: A step of united nations and European union to end violence against women
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
July-August 2018, 11(4):380-381
  783 95 -
How to improve the outcome in empyema thoracis
Vishnu Sharma Moleyar
July-August 2018, 11(4):324-325
  760 86 -
Can the family physician make a comeback?
Vadisha Srinivas Bhat
July-August 2018, 11(4):379-380
  707 72 -
Ectodermal dysplasia
Panduranga Chikkannaiah
July-August 2018, 11(4):355-356
  699 70 -
Acute fulminant necrotizing amebic pancolitis
Viroj Wiwanitkit
July-August 2018, 11(4):342-343
  705 52 -
Apert syndrome with respiratory distress in a newborn: Our experience in a rural setting
Ibrahim Aliyu
July-August 2018, 11(4):381-382
  647 60 -