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   2016| January-April  | Volume 30 | Issue 1  
    Online since February 5, 2016

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Disability among the elder population of India: A public health concern
Amit Agrawal
January-April 2016, 30(1):15-19
The Government of India adopted the National Policy on Older Persons in 1999, which defines a "'senior citizen' or 'elderly' as a person who is of age 60 years or above." In India the elderly population accounted for 8.2% of the total population in 2011 and the number is expected to increase over the next decades. The link between aging and disability is a biological fact, and disability in the elderly is an important health indicator pointing to jeopardized quality of life. But at the same time, aging should not be treated as synonymous with disability as a large proportion of older people live with good health status. There are many studies from India that have addressed disability in the elderly population; however, they lack uniformity in defining disability and largely address mostly one aspect, that is, the medical model of disability. It is well recognized that "disability and elderly" encompasses a much larger spectrum of the conditions with unique requirements and needs to be studied as a much broader concept.
  6,690 847 3
Identification of biomarkers for prediction of preterm delivery
Jigna Shah, Bhavya Baxi
January-April 2016, 30(1):3-14
Preterm birth is one of the most prevailing complications of pregnancy causing neonatal mortality and morbidity. Cervical length measurement has been the only criteria used till now for the prediction of preterm delivery (PTD). Research on many biomarkers in maternal serum, amniotic fluid, and cervicovaginal fluid (CVF) has been accomplished such as fetal fibronectin (FFN), α-fetoprotein, C-reactive protein (CRP), multiple members of the interleukin family (interleukin-6, interleukin 8, and interleukin 10), matrix metalloproteinases, pregnancy-associated plasma protein A, relaxin, lactate dehydrogenase (LDH), thyroid-stimulating hormone, adrenocorticotropic hormone, vascular endothelial growth factor (VEGF), ferritin, prolactin, ceruloplasmin, alkaline phosphatase (ALP), glucose, placental protein 13, corticotropin releasing hormone, tumor necrosis factor-α (TNF-α), tumor necrosis factor-β (TNF- β), estriol and human chorionic gonadotropin (hCG). Not a single biomarker has been evolved till date, which possesses sensitivity as well as reliability for the detection of spontaneous preterm birth. The variability in results across the studies may have arisen due to dissimilarities in study designs, different timings of collection of blood, and diversities in the study population. Study on a large sample size is needed for the confirmatory conclusion of use of biomarker in PTD. A single biomarker or even in combination, if found for the prediction of preterm labor (PTL), can decrease the hospital cost as well as restrict the treatment.
  5,451 684 1
Dysmenorrhea among higher secondary schoolgirls of Imphal West district, Manipur: A cross-sectional study
K Sathish Kumar, Shantibala Konjengbam, Hanjabam Sanayaima Devi
January-April 2016, 30(1):38-43
Background: Dysmenorrhea is one of the common problems experienced by many adolescent girls after the onset of menarche. Objectives: This study had the following objectives: 1. To determine the prevalence of dysmenorrhea among adolescent girls; 2. To determine the association between dysmenorrhea and selected variables of interest; 3. To assess the effect of dysmenorrhea on quality of life; 4. To assess treatment-seeking practices for dysmenorrhea. Materials and Methods: This was a cross-sectional study conducted among higher secondary schoolgirls of Imphal West district, Manipur from December 2012 to September 2014. The sample size was calculated to be 660. Participants were selected by stratified two-stage cluster sampling. Data were collected using a self-administered questionnaire. Data were entered and analyzed using IBM SPSS version 20 (Armonk, New York, USA). Analysis was done using chi-square test and chi-square test for trend. Results: Among the 703 respondents, the prevalence of dysmenorrhea was 76.0%, and about one-fifth (21.2%) of the respondents were suffering from severe dysmenorrhea. Painful menstruation caused school absenteeism, poor exam grades, and poor interpersonal relationships, decreased concentration in class and affected daily physical activities in the majority of respondents. Only 37.5% of the dysmenorrheic girls were receiving treatment for painful menstruation, of which medication was the common, but only 13.1% of the dysmenorrheic girls took medication on prescription by a doctor. Conclusion: Health education on issues related to reproductive health should be incorporated early enough in the school curriculum to prepare girls for menstruation and inform them about available treatment options for dysmenorrhea.
  5,640 478 2
Hospital's liability in malpractice suits
Thounaojam Meera, Memchoubi Phanjoubam, Huidrom Nabachandra
January-April 2016, 30(1):1-2
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Manipulation and orthosis in the management of congenital talipes equinovarus
Asem Rangita Chanu, Naorem Bimol, Bijendra Rai, Kunjabashi Wangjam, Nongmaithem Romi Singh
January-April 2016, 30(1):27-30
Background: There have been controversies regarding the ideal treatment method for congenital talipes equinovarus (CTEV). It is now accepted that conservative management is the first line of management. Aims: To find out if manipulation and maintenance of the correction achieved with a dynamic CTEV orthosis can correct CTEV deformities. Study Settings: Department of Physical Medicine and Rehabilitation in a tertiary care teaching institute, Imphal. Study Design: Intervention study without comparison group. Materials and Methods: Fifteen patients (twenty-one CTEV feet) were enrolled in the study. Manipulation with the head of talus as fulcrum was performed without any attempt to separately correct cavus and other deformities from the beginning. This procedure was repeated ten times for a minimum of three sittings daily. Correction so achieved was maintained with a dynamic CTEV orthosis manufactured with polypropylene plastic. The CTEV orthosis was worn throughout the day except during manipulations and bathing. Roentgenography was performed before the start and at the end of the treatment to assess improvement. Statistical Analysis: Wilcoxon signed-rank test was used to assess the improvement in the radiological angles from baseline to the last follow-up. Results: The differences in the paired X-ray angles [talocalcaneal angle-lateral (TCA-LAT), tibiocalcaneal angle-lateral (TibCA), talocalcaneal angle-anteroposterior (TCA-AP), talo-first metatarsal angle-anteroposterior (TMT)] between the baseline and the sixth follow-up were statistically significant (P < 0.001). Conclusion: Proper daily manipulation by a caregiver and maintenance of correction with appropriately designed dynamic ankle-foot orthosis is a practical and effective means of correcting CTEV deformity.
  3,432 230 -
The role of endoscopic sinus surgery in maxillary sinus foreign body removal
Birjit Singh Oinam, Jiten Singh Ningombam, Sobita Devi Puyam, Sudhiranjan Thingbaijam
January-April 2016, 30(1):61-63
Extraction of impacted third molars is a common surgical procedure performed by oral surgeons and dentist. Dislodgement of the molar tooth into the maxillary sinus cavity can occur during the procedure. It comprises 0.6-3.8% of iatrogenic foreign body entrapment in the paranasal sinus. We report an unusual case of impacted maxillary third molar tooth that was accidentally displaced into the maxillary sinus during extraction and remained almost 1 year without any symptoms and removed via endoscopic sinus surgery.
  3,373 218 1
Forensic odontology
Nitai Debnath, Renu Gupta, Rajesh Singh Nongthombam, Preety Chandran
January-April 2016, 30(1):20-23
Forensic odontology is a relatively new science that utilizes the dentist's knowledge to serve the judicial system. Forensic odontology deals with human identification based on dental records, bitemarks, lip print, tooth print, and palatal rugae pattern. Human identification heavily relies on the quality of dental records in the office. Dental record includes documents related to the history of present illness, clinical examination, diagnosis, treatment done, and prognosis of treatment. The quality dental records are useful not only in forensic science but also in legal implications such as insurance and consumerism. This article primarily aims at making general practitioners aware about the importance of keeping the various types of dental records and its implication in forensic odontology.
  2,711 355 -
Prevalence of Chlamydia trachomatis in a tertiary center in South India
Yohen Nandeibam, Shakti Laishram, Jessie Lionel
January-April 2016, 30(1):31-34
Objective: To determine the prevalence for Chlamydia trachomatis and the need for introduction of screening test for chlamydia infection in patients attending a gynaecology outpatient clinic. Materials and Methods: Ninety-nine patients had endocervical swabs taken during pelvic examination, after an informed consent and tested using the Clearview ® chlamydia test kit. Results: Overall prevalence of infection was 10%. Conclusion: There is a high prevalence of C. trachomatis which warrants introduction of screening.
  2,074 233 -
Moving toward the universal health coverage: A strategy to expedite health equity
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
January-April 2016, 30(1):70-71
Among the multiple goals set in the field of health for the nations and the general population, ensuring universal health coverage (UHC) is of extreme priority. Globally, it has been anticipated, that by achieving UHC, it will not only help to negate social inequity, but even aid the stakeholders in their mission to ensure sustainable development and minimize poverty, especially in middle- and low-income nations. The findings of a recently released report have suggested that close to 400 million people were devoid of one of the essential health services, and hence there is an indispensable need to expand the reach of health services. In conclusion, the scope of UHC is much more than just health, set with a primary objective of extending quality assured essential health services in order to improve the health standards of the beneficiaries, without compromising the financial status of the family. Thus, by moving toward UHC, it will help nations to achieve equity and social inclusion.
  1,977 309 2
Pattern of extremity fractures among patients with musculoskeletal injuries: A hospital based study from North India
Bhanu Awasthi, Sunil Kumar Raina, Naveen Kumar, Vipin Sharma, Sandeep Kalia, Lokesh Thakur
January-April 2016, 30(1):35-37
Background: A study on the pattern of fracture is an important area of public health. Analysis of skeletal fracture data is the essence of fracture epidemiology. Objective: To find out the pattern of extremity fractures among patients with musculoskeletal injuries. Materials and Methods: The study was a prospective, descriptive hospital based, conducted over a period of 1 year at a tertiary care center in a rural area of Himachal Pradesh, a sub-Himalayan state of India. Results: The most common fracture in upper extremities was distal end radius (n = 150, 17.2%) followed by fracture both bone forearm (n = 59, 6.7%). The most common fracture in lower extremities was both bone leg (n = 68, 7.8%) followed by fracture metatarsals (n = 52:5.9%). Conclusions: Understanding pattern of fractures may help plan prevention and management strategies for fractures.
  2,010 181 1
Giant aggressive angiomyxoma of the vulva
Harsh Kumar, Banyameen Iqbal, Bharat Bhushan Dogra, Shrish Chandanwale
January-April 2016, 30(1):58-60
Aggressive angiomyxoma (AA) is rare, soft, myxoid, mesenchymal neoplasm arising in the Pelvis and Perineal regions, which is locally aggressive. We are reporting a case of a 17-year-old female who presented with a well-circumscribed pedunculated polypoidal mass in the right labium majora diagnosed to be AA. Surgical excision was done, and histopathological examination confirmed it to be AA.
  1,947 169 -
A comparative study of spinal anesthesia with hyperbaric ropivacaine plus fentanyl and hyperbaric bupivacaine plus fentanyl in lower abdominal surgery and lower limb surgery
Kuber Khundongbam, Pradipkumar Laithangbam, Takhelkmayum Hemjit, Jack Asem, Eshori Longjam
January-April 2016, 30(1):50-54
Background: Ropivacaine 15 mg is found to be equivalent to 10 mg bupivacaine for knee surgery in terms of hemodynamic stability and degree of motor blockade under spinal anaesthesia. The efficacy of hyperbaric preparations of the similar doses, when mixed with an opioid was evaluated in this study. Methods: Sixty adult patients, of both sexes with American Society of Anaesthesiologists status I/II undergoing lower abdominal and lower limb surgery were enrolled in this prospective, randomized, double blind study. Patients were randomly assigned into two groups: group B (bupivacaine group) and group R (Ropivacaine group). Patients in group B (n = 30) received hyperbaric 0.5% bupivacaine (2 ml) with fentanyl 0.4 ml and normal saline (0.25 ml). Group R patients received ropivacaine 0.75% (2 ml) with fentany l 0.4 ml, 0.2 ml of 50% dextrose and normal saline (0.05 ml). The spinal block characteristics, hemodynamic parameters, and onset time to pass urine were recorded and statistically analyzed. Results: There were no differences between the two groups in the mean time to attain highest sensory block level (group R 9.10 ± 1.97 min; group B 9.17 ± 1.51min; P > 0.05) and median maximum extent (ropivacaine T6; bupivacaine T5; P > 0.05); but the mean duration of sensory block regression to S2 was significant (ropivacaine 157.44 ± 17.78 min; bupivacaine 180.60 ± 23.06 min; P < 0.001). The degree of motor block by 5 min was significantly different between the groups (ropivacaine 1.50 ± 0.82; bupivacaine 2.40 ± 0.49; P < 0.001). Patients receiving ropivacaine mobilized sooner (ropivacaine115.47 ± 17.07 min; bupivacaine 154.60 ± 20.37 min; P < 0.001) and passed urine sooner (ropivacaine 236.38 ± 90.44 min; bupivacaine 289.85 ± 73.21 min; P = 0.037). Three patients in group B required treatment for hypotension. Conclusion: Hyperbaric ropivacaine 15 mg with fentany l 20 μg was found to be a better alternative to bupivacaine (heavy) 10 mg with better block characteristics and hemodynamic stability.
  1,882 202 -
Treatment of retained placenta with sublingual misoprostol: A case report
Rashmi Bala, Sumit Shukla Das, Laiphrakpam Ranjit Singh
January-April 2016, 30(1):67-68
Retained placenta is a common complication of the third stage of labor. It can be due to an atonic uterus, a trapped placenta, or an adherent placenta. The most common source of a trapped placenta is from a partial closure of the cervix and/or a contracted lower uterine segment. We present an unusual case of a trapped placenta managed by Misoprostol [prostaglandin (PG) E1] administered sublingually with spontaneous expulsion of the placenta on the 21 st day after delivery.
  1,882 166 -
Comparison between two different fractionation radiation dose schedules for palliation of advanced solid tumours
Cindy Laltanpui, Yengkhom Indibor Singh, Yongba Waulong Phom
January-April 2016, 30(1):24-26
Context: Palliative radiotherapy (RT) is radiation treatment administered with the intent to improve symptoms and relieve suffering. Aims: The aim of this study is to compare between two different fractionation radiation Dose schedules for palliation of advanced solid tumours. Setting and design: An interventional study carried out in the Department of Radiotherapy, RIMS. Materials and Methods: The study population comprised of 60 patients who were histopathologically confirmed patients with dyspnea in lung cancer, bleeding in cervical cancer and pain in rectal cancers. The eligible patients were randomized into two arms, Arm A and Arm B with a 1:1 randomization, consisting of 30 patients in each arm. Patients in Arm A were prescribed tumor dose of 20 Gray (Gy) over 5 fractions (that is 400 cGy per fractions) and the patients in Arm B were prescribed tumor dose of 10 Gy as weekly dose for 2 fraction. Theratron 780-C Cobalt 60 unit (80 cm SSD) was used. Statistical analysis used: statistical packages for the social sciences (SPSS) version 11.5. Result: In both treatment arms, mean symptoms grade of dyspnoea, mean pain scores and mean bleeding grade scores, improved from week 0-12 with better grades in Arm B group which indicated adequate palliation. Conclusion: 10 Gy into 2 fractions once a week (Arm B) gives better symptom palliation than 20 Gy over 5 fractions (Arm A) in advanced solid tumors like lung, rectal and cervix cancers with more toxicities in Arm B.
  1,668 191 1
Nutritive and medicinal value of capsicum
Dipika Singh, Roopesh Jain
January-April 2016, 30(1):69-69
  1,661 156 1
An unusual cause of recurrent falls
Piyush Ostwal, Varsha S Dabadghao, Suresh K Sharma, Anurag Aggarwal
January-April 2016, 30(1):55-57
Patient with recurrent falls presenting to the physician poses a diagnostic and therapeutic challenge. Detailed clinical and laboratory evaluation often results in precise diagnosis. We present here a case who presented with recurrent falls and was diagnosed to have myotonia congenita (MC) of Becker's type. He had typical clinical signs of myotonia such as grip myotonia and percussion myotonia. Myotonic disorders should be considered in patients presenting with recurrent falls and clinical testing for myotonia should be done. Electromyography and muscle histopathology are important adjuncts to the diagnosis of MC.
  1,648 119 -
Embryological analysis of a case of exstrophy of the cloaca
Chongtham Rajlakshmi, Tanusri Debbarma
January-April 2016, 30(1):64-66
A case is reported here of a stillborn fetus of about 21 weeks of gestation that was collected from the Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India. The weight of the fetus was around 350 g. Crown rump (CR) length was not taken because of spine deformity and, therefore, the foot length, which measured 3.3 cm, was used to determine the age of the fetus. External examination of the fetus revealed an enormous defect in the anterior abdomen wall (omphalocele). The umbilical cord was attached on the right side of omphalocele. Incision of the membranous sac revealed liver, coils of intestine, and a muscular sac herniating through the defect in the abdominal wall. Further exploration of the abdomen showed continuity of the large intestine and ureters to the muscular sac. The sac is the cloaca. Exstrophy of the cloaca is a rare developmental anomaly involving the urinary bladder and the distal part of the digestive tract. This case report discusses the embryological background of the development of exstrophy of the cloaca and is reported because of the association of complete absence of external genitalia.
  1,593 101 -
Genetic analysis of EGFR mutations in non-small cell lung carcinoma: A tertiary care center experience
Reena Bharadwaj, Khushboo Dewan, Navdeep Mann
January-April 2016, 30(1):44-49
Background: In the past decade, the association of epidermal growth factor receptor (EGFR) mutations with response to tyrosine kinase inhibitor "gefitinib" has revolutionized the treatment of lung adenocarcinomas. The research done in the West has suggested an association of EGFR mutation with factors such as female sex, nonsmoker status, and adenocarcinoma. Aim: This study was aimed to find the prevalence of EGFR mutations in lung cancer in the Indian population and its association with clinicopathological parameters. Materials and Methods: Sixty cases of non-small cell lung carcinoma (NSCLC) were studied histomorphologically and immunohistochemically for EGFR protein expression and for EGFR gene mutations by sequencing. The statistical analysis was done by calculating P value using Chi-square test. Results: Statistically significant relation of adenocarcinoma with female sex and nonsmoker status was noted. EGFR mutations were seen in 30% of NSCLC and 70% of lung adenocarcinoma cases. Statistically significant relation of EGFR mutations with female sex, nonsmoker status, and adenocarcinoma histology, particularly of the bronchioloalveolar type was noted. No relation of EGFR mutation with the age of the patient and the stage of the tumor was observed implying that EGFR mutation is an early event in the pathogenesis of lung adenocarcinoma. Exon 19 deletions were the most common type of EGFR mutations, with a higher prevalence in the male patients. Exon 21 and 18 mutations were also observed, particularly in females. No relation between EGFR mutations by sequencing and EGFR protein expression by immunohistochemistry was observed. Conclusion: In the Indian population, the prevalence of EGFR mutations in NSCLC is higher than that in the West, and it is associated with female sex, non-smoker status, and adenocarcinoma. Exon 19 deletions are the most common type of EGFR mutations. Immunohistochemistry for EGFR does not correlate with EGFR mutations and cannot be used as its substitute for deciding gefitinib treatment.
  1,539 138 -