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   2018| January-June  | Volume 6 | Issue 1  
    Online since June 11, 2018

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Historical perspectives on personality – The past and current concept: The search is not yet over
Krishnamurthy Kavirayani
January-June 2018, 6(1):180-186
Personality is the way we think, feel, perceive, and react to the external world, which has been thought of by different workers since ancient times. The number of theories itself reflects that personality is not an homogenous entity and the development of personality is biopsychosocial as viewed by psychiatrists and psychologists of different times.
  48,750 1,975 1
Neuropharmacological classification of antidepressant agents based on their mechanisms of action
Olumuyiwa John Fasipe
January-June 2018, 6(1):81-94
The currently available clinical antidepressants can be classified into 13 different classes based on their mechanisms of action. These basic pharmacological concepts thoroughly elucidate and unravel the therapeutic actions and side effects of the wide range of antidepressants currently available. The two classical mechanisms are exhibited by tricyclic antidepressants (TCAs) and by monoamine oxidase inhibitors (MAOIs). Regarding the 11 relatively nonclassical antidepressants, the most widely prescribed agents are the selective serotonin reuptake inhibitors (SSRIs). The mechanisms of action for the other classes of antidepressants that exhibit additional actions on serotonergic neurotransmission are dual serotonin-norepinephrine reuptake inhibition (SNRI), serotonin receptors antagonism with serotonin reuptake inhibition (SARI), serotonin 5-HT1Aautoreceptor partial agonism with serotonin reuptake inhibition (SPARI), serotonin-norepinephrine reuptake inhibition and serotonin receptors antagonism antidepressant with potent antipsychotic D2 receptor blockade/antagonism (SNRISA with potent antipsychotic D2 receptor blockade/antagonism), norepinephrine reuptake inhibition with serotonin receptors antagonism (NRISA), noradrenergic α2-receptor antagonism with specific serotonergic receptors-2 and-3 antagonism (NASSA), and atypical antipsychotics that exhibit weak D2receptor antagonism with potently strong 5-HT2Areceptor blockade. Furthermore, the two classes that exhibit selective norepinephrine reuptake inhibition (NRI) and dual norepinephrine-dopamine reuptake inhibition (NDRI) define separate novel classes of antidepressants that have a direct action on the noradrenergic neurotransmission system but have no direct action on the serotonergic neurotransmission system, while the last remaining one class of N-methyl-D-aspartate-glutamatergic ionoceptor antagonist/inverse agonist/partial agonist also represents a separate novel class of antidepressants with a direct action on the excitatory glutamatergic neurotransmission system but no direct action on the serotonergic, noradrenergic, or dopaminergic neurotransmission systems. Lastly, this review remarkably advocates for the incorporation of the atypical antipsychotics and NMDA-glutamatergic ionoceptor antagonist/inverse agonist/partial agonist as new member classes of the antidepressant agents because of their clinically significant roles in the management of depression disorders.
  36,764 3,000 24
Novel herbal drug delivery system: An overview
Manoj Kumar Sarangi, Sasmita Padhi
January-June 2018, 6(1):171-179
The kind of novel herbal formulations such as polymeric nanoparticles, nanocapsules, liposomes, phytosomes, animations, microsphere, transfersomes, and ethosomes has been reported using proactive and plant selections. The novel formulations are described to have remarkable advantages over conventional formulations of plant actives and extracts which include enhancement of solubility, bioavailability, and protection from toxicity, enhancement of pharmacological activity, enhancement of stability, improved tissue macrophages distribution, sustained delivery, and protection from physical and chemical degradation. Phytosome is a patented technology developed by a leading maker of drugs and nutraceuticals, to incorporate standardized plant extracts or water-soluble phytoconstituents into phospholipids to produce lipid-compatible molecular complexes. The herbal drugs can be used in a more upright course with enhanced efficacy by incorporating them into modern dosage forms. This can be accomplished by designing novel drug delivery systems for herbal ingredients. The present review highlights the current condition of the development of novel herbal formulations and summarizes their type of active components, biological activity, and applications of novel formulations.
  13,785 1,326 7
Health-related quality of life among menopausal women
Thilagavathy Ganapathy, Samia Saud Al Furaikh
January-June 2018, 6(1):16-23
Background: Menopausal symptoms impact physical, psychological, vasomotor, and sexual health-related quality of life (QOL) among women. Objective: This exploratory study aimed to assess the effects of menopausal symptoms on the QOL using Menopause-Specific QOL Questionnaire (MENQOL) among women in India. Materials and Methods: By purposive sampling, n = 140 women aged between 40 and 60 years were recruited, and the prevalence of menopausal symptoms and its relationship with physical, psychological, vasomotor, and sexual health-related QOL was assessed using MENQOL, at Arekare, Mico-Layout, Bangalore South, Karnataka, India. Results: The mean age at menopause was 49.59 + 3.09 years. Nearly 97.14% of women reported having experienced minimum five or more menopausal symptoms. The prevalence of symptoms in physical, vasomotor, psychological, and sexual domains was 74.56%, 60.7%, 44.68%, and 26.4%, respectively. An overall mean MENQOL score of physical (27.1 + 0.72), psychological (2.01 + 0.27), vasomotor (4.08 + 0.79), and sexual (3.89 + 0.59) health-related QOL among menopausal women showed poor QOL. Statistical significant differences were observed between the sociodemographic variables and the health-related QOL scores in all domains at P < 0.05. Conclusion: Menopausal women-centered integrated model of care would empower women to lead improved health-related QOL in the next one-third of postmenopausal life span development.
  13,045 1,319 6
Revisiting hansen's disease: Recognizing the many neurodermatologic faces and its diagnostic challenges
Bhaskara P Shelley, Manjunath Mala Shenoy
January-June 2018, 6(1):157-170
Hansen's disease (HD) looms still as a public health problem. Conventional wisdom and teaching largely view HD as a predominantly dermatologic disorder with much emphasis in the dermatology postgraduate curriculum. This review attempts to reorient this view and reemphasize that HD has primarily neurologic underpinnings since Mycobacterium leprae is an intracellular neurotropic bacterium. The main thrust of this article would, therefore, be a neurologist's perspective of HD. The cutaneous manifestations of HD are the sequelae of the neurobiology of M. leprae, its selective predilection to human Schwann cells, neurovascular bundle and its localization in the intracutaneous nerve plexus of the skin. We discuss the nuances of HD as a “great imitator,” the many faces of its neurodermatologic clinical presentation, the neurologic basis of HD clinical examination, and its diagnostic and therapeutic challenges.
  12,103 993 3
Dietary and antioxidant therapy for autistic children: Does it really work?
Lubna A. G. Mahmood, Reem Al Saadi, Lorraine Matthews
January-June 2018, 6(1):73-80
Autism or autism spectrum disorder are both general terms for a group of complex neurodevelopment disorders that are characterized by social impairments, communication difficulties, impaired social interaction, verbal and nonverbal communication, repetitive, and stereotyped behaviors as well. Autism has a significant genetic basis; even the genetics of autism are complex and mostly unclear if it is explained by rare multigene interactions of common genetic variants or rare mutations with major effects. Autism is known as a severe neurodevelopmental disorder with a poorly understood etiology. The oxidative stress in autism has been studied at both the membrane level as long as measuring products of lipid peroxidation, antioxidants, and detoxifying agents (such as glutathione) involved in the defense system against reactive oxygen species. Antioxidants have some potential therapeutic value in the treatment of certain neurodegenerative diseases though catabolizing H2O2. Since mitochondrial dysfunction is involved in the pathogenesis of many neurodegenerative diseases such as autism disorder, so developing new therapeutic strategies targeting the mitochondria may shed a new light to autism treatment. Given the evidence hinting at neurological changes following the implementation of dietary intervention in related conditions, future research might also benefit from looking at brain structural and biochemical changes in cases of altered state of consciousness (ASCs) adopting dietary intervention. Indeed, the gut-brain relationship, seemingly so important to explaining the role of dietary intervention in best-responder cases, is a woefully under-researched area with ASCs in mind.
  12,537 520 2
Comparative assessment of basic life support knowledge between professional nurses and nursing students
Basma Salameh, Ahmad Batran, Ahmad Ayed, Mohammad Zapen, Ali Ammash, Abdelsalam Taqatqa, Mohammad Nasar, Doha Naser
January-June 2018, 6(1):54-58
Background and Aim: It is equally important to highlight the necessity of teaching basic life support (BLS) to undergraduate nursing students so they can be equipped with BLS knowledge and skills to be able to handle critical cases during their training and in their future practice. This study aimed to assess the knowledge of BLS on the part of nursing professionals and students at the Arab American University of Jenin. It also sought to identify any link between BLS knowledge and such related factors as gender, age, education level, years of experience, etc. Materials and Methods: A cross sectional descriptive was conducted among 150 registered nurses from 4 governmental hospitals in districts covering the north, south and middle of Palestine, and 150 nursing students from the Arab-American University in Jenin in the period between 24 April 2017until 1 June 2017. Data was collected using a structured questionnaire developed by researchers and AHA BLS instructors, who are responsible for collecting information regarding basic knowledge on BLS resuscitation. Results: The result of this study acknowledges that registered nurses have higher average BLS knowledge score (56.7%) compared to nursing students at AAUJ (48.6%). Also, a highly significant difference between both groups in regards to BLS knowledge (p=0.001) was established. Conclusion: Nurses show a higher level of BLS knowledge than do nursing students. Evaluating knowledge in BLS theory and practice is necessary to mitigate possible disability or death caused by a time lag in resuscitation. The inclusion of BLS in nursing curriculum is essential.
  11,585 803 -
Recent advances and current trend in the pharmacotherapy of obesity
Olumuyiwa John Fasipe
January-June 2018, 6(1):99-116
Nonpharmacological approach to the prevention and treatment of obesity includes considerable lifestyle changes such as adequate physical exercise, smoking cessation, limiting alcohol intake, avoiding sedentary lifestyles, intensive behavioral counseling (psychotherapy), proper nutritional (dietary) programs, and bariatric surgery. For a pharmacotherapeutic substance to be regarded as an anti-obesity drug, it has to demonstrate a reduction of at least 5%–10% in the baseline body weight within a year of commencing treatment. Pharmacotherapeutic agents used to treat obesity include sympathomimetic appetite suppressant drugs, pancreatic lipase inhibitors, antidiabetic drugs, serotonin 5-HT2Cagonists, anticonvulsant drugs, atypical antidepressants, hormones, selective β3adrenoceptor agonists, and various combination preparations. The choice of agent should be individualized and dictated by patient comorbidities, relative contraindications, available clinical trial evidence, and clinical expertise. In addition to pharmacological therapy, all anti-obesity drugs should be prescribed with the premise of dietary caloric restriction and exercise. Bariatric surgery is the most effective treatment for obesity when the other forms of intervention have failed to produce a clinically significant weight loss in individuals with a body mass index of ≥35 kg/m2. Finally, concerning the prospective future research directions on the pharmacotherapy of obesity, a number of initiatives have been put forward to develop a peripherally restricted CB1receptor antagonist (such as TM38837 compound) that targets only the peripheral CB1receptors by restricting their ability to cross the blood–brain barrier in order to avoid the serious and severe psychiatric adverse effects found to be associated with the unrestricted CB1receptor antagonists such as rimonabant.
  9,977 1,074 4
Typhoid intestinal perforation: Analysis of the outcome of surgical treatment in Kano, Nigeria
Abdurrahman Abba Sheshe, Lofty-John Chukwuemeka Anyanwu, Aminu Mohammad Mohammad, Abubakar Bala Muhammad, Stephen K Obaro
January-June 2018, 6(1):59-63
Background: Intestinal perforation is a serious complication of typhoid fever with high case fatality rates in developing countries. This study aims to determine the factors associated with an adverse clinical outcome among patients managed for typhoid intestinal perforation (TIP) in our hospital. Materials and Methods: We retrospectively reviewed the records of all patients presenting to our general surgery unit with TIP between January 2012 and December 2015. The patients were categorized based on postoperative outcome status and the patient-related variables were compared and analyzed for determinants of outcome, using the Chi-square test. A statistical significance was assigned to a P < 0.05. Results: There were fifty patients who had surgery for TIP during the study period, but only the records of 47 patients could be retrieved for analysis. Of these, 32 (68.1%) were males and 15 (31.9%) were females. The male/female ratio was 2.13:1. Their ages ranged from 13 to 55 years with a median of 17 years. A single intestinal perforation was seen in 87.2% (41/47), while 12.8% (6/47) had two or more. The mortality rate was 8.5% (4/47). The occurrence of a postoperative fecal fistula was significantly (P = 0.016) associated with a postoperative mortality. A peritoneal aspirate volume >1000 ml was significantly associated with having a postoperative fecal fistula (P = 0.011) and postoperative mortality (P = 0.002). A number of intestinal perforations were not significantly associated with an adverse outcome (P > 0.05). Conclusion: Postoperative fecal fistula adversely affected the outcome of the patients in our series. Multiple intestinal perforations did not seem to affect the outcome in our patients.
  9,536 534 4
The invisible illness of depression: “Never Say Never Mind, Mind the Mind,” and Mind the “Science Gap”
Bhaskara P Shelley
January-June 2018, 6(1):1-11
  9,042 811 -
Immunohistochemical characterization of small round blue cell tumors of childhood at Ile-Ife, Nigeria: A 10-Year retrospective study
Ifeoma Florence Ezejiofor, Kayode Adelusola, Muheez Alani Durosinmi, Lorenzo Leoncini, Willians Olufemi Odesanmi, Maria Raffaella Ambrosio, S Lazzi, Rinde O. O. Olaofe, Gloria Gbutorano
January-June 2018, 6(1):64-69
Background: Immunostains when used in correlation with clinical site of tumours and morphology permits accurate and specific diagnosis of these undifferentiated tumours. Materials and Methods: A ten-year retrospective research of the histopathological and immunohistochemical features of small round blue cell tumours (SRBCT) in OAUTHC was analyzed. Pathology reports of all SRBCT and their blocks were retrieved and recut slides reviewed to determine each tumour types. Acute myelocytic lymphoma/leukeamias and Glioblastoma multiformis were excluded from SRBCT of childhood. Eighty four (84) cases that fulfilled the inclusion criteria were analyzed using immunohistochemistry. Results: The age range of presentation was 0-15 years (Mean 5.98±3.964 year S.D.). Retinoblastoma and Wilms' tumours were the commonest histological sub-types with a percentage of 20.0% each followed by Burkitt lymphoma (17.6%), rhabdomyosarcoma (9.8%) which was the only soft tissue sarcoma found. The least represented was supra-tentorial CNS-PNET (1.2%). Eighty four blocks of SRBCT were subjected to different panels of immunohistochemistry. Of all these tumours 36 cases had a change in diagnosis: 23 cases had an initial, pre-immunohistochemical umbrella diagnosis ranging from NHL, SRBCT to no pathological diagnosis at all. Seven (7) cases with initial diagnosis ranging from Ewing's sarcoma (1 case), retinoblastoma (1 case) to rhabdomyosarcoma (5 cases) were finally confirmed with immunostains as Burkitt lymphoma (BL) while one case of BL was finally confirmed as rhabdomyosarcoma. The last five of the 36 cases were totally non-neoplastic lesions but had histology diagnosis ranging from NHL, spinal cell sarcoma to periosteal osteosarcoma. The immunostains done on these 5 cases revealed erythroid hyperplasia with dyserythropoiesis, cellular neurofibroma, fibrous dysplasia, reactive follicular hyperplasia and normal retinal tissue. Conclusion: Application of immunohistochemistry does indeed enhance the diagnostic accuracy of these undifferentiated tumors.
  7,449 512 1
Evaluation of a rapid dipstick test (Crystal Vc®) for the diagnosis of cholera in Maiduguri, Northeastern Nigeria
Ballah Akawu Denue
January-June 2018, 6(1):24-27
Background: Cholera is a preventable diarrheal disease associated with rapidly progressing dehydration. Early detection of the causative agent, Vibrio cholerae (VC) among symptomatic patients is a key step in cholera outbreak management to minimize disease spread and mortality. Materials and Methods: We prospectively evaluated the performance of Crystal VC®, a commercially available test kit for rapid detection of VC serotypes 01 and 0139 directly from stool samples. Patients included in this study were those admitted to the cholera treatment unit from August 14, 2017, to September 20, 2017, during the cholera outbreak in Maiduguri, northeastern Nigeria. Conventional bacterial stool culture is considered the gold standard and was used as the comparator. Results: A total of 156 stool specimens were collected and tested. Compared with stool culture results, the Crystal VC® test had sensitivity (SE) of 95.1% and specificity (SP) of 59.3%. The positive and negative likelihood ratios were 2.33 and 0.08, respectively. The positive predictive value (PPV) was 81.5% while the negative predictive value (NPV) was 86.5%. There was no gender variation with respect to SE, SP, PPV, and NPV. Conclusion: The cholera rapid dispstick test (RDT), Crystal VC®, is a useful tool for diagnosis of diarrheal disease due to VC serotypes 01 and 0139 and may provide an initial alert in an outbreak situation. It may also be used for case surveillance in cholera epidemic prone situations resulting from displacement to camps or overcrowded shelters due to human conflict or natural disasters. Although it is less sensitive than conventional stool culture, it is a convenient and simple test to perform with faster turnaround time.
  6,936 541 3
First case report of surgical site infection due to Buttiauxella agrestis in a neurocare center in India
Nivedita Patra, Mridula Raj Prakash, Shripad Patil, Malla Bhaskar Rao
January-June 2018, 6(1):117-119
Buttiauxella agrestis, a member of the Enterobacteriaceae family, is usually isolated from soil, water, fish, mollusks, and rarely associated with human infections. Here, we report a rare case of postcraniotomy surgical site infection by B. agrestis in a neurosurgical center which was easily controlled by antibiotic. To the best of our knowledge, this is the first case report from India implicating B. agrestis as a cause of human infection. The infection along with microbiological characteristics and clinical significance of the organism is described.
  6,894 332 2
Multifocal skeletal tuberculosis mimicking multiple myeloma and secondary bone metastasis: An unusual case scenario
Gurjeet Singh Chowdhary, Abhishek Purkayastha, Ritu Mehta
January-June 2018, 6(1):126-129
Skeletal tuberculosis (TB) is rare, accounting for 1%–2% of all cases of TB with multifocal involvement being rarer. Bones most commonly involved are the spine, joints, shoulder girdle, sternum, pelvis, ribs, skull, and orbit. We hereby report such multifocal bone TB in a 58-year-old-male who presented with complaints of pelvic pain of 2 months' duration. Radiograph of pelvis showed lytic lesions left ilium. A differential diagnosis of multiple myeloma and secondary bone metastasis was initially thought of. Computed tomography scan, magnetic resonance imaging, and bone scan pointed toward metastatic bone involvement. Metastatic workup with positron emission tomography scan and myeloma workup were negative. Biopsy from the lytic bony lesion was done which revealed TB with Ziehl–Neelsen staining positive for acid-fast bacilli. He was diagnosed as a case of primary bone TB and was commenced on antitubercular therapy to which he responded significantly. This case is being reported to highlight its extreme rarity, the diagnostic and therapeutic challenges it presented, and the overall prognosis of this condition.
  6,377 323 2
A randomized controlled trial to compare efficacy of collagen granule-based dressing versus conventional dressing in the management of diabetic foot ulcers
SS Shimikore, Gaurav B Pawar
January-June 2018, 6(1):28-31
Background and Objective: Diabetic foot ulcers are the most common reason for frequent hospitalization of diabetic patients. Management of ulcers by appropriate clinical practices such as thorough dressing and sterile wound creation to achieve improved mobility as well as completeness of healing are the significant goals of the clinicians. The current study aimed to compare the efficacy of collagen granule-based dressing over the conventional dressing in the management of diabetic foot ulcers. Materials and Methods: A randomized controlled trial was conducted from January 2013 to December 2013. A total of 60 patients having diabetic foot ulcers were studied. Routine investigations such as complete blood count, fasting blood sugar, culture and antibiotic sensitivity, and X-ray of the foot were performed. Patients were divided into two groups: group A (n = 30; treated with topical collagen granules dressing) and Group B (n = 30; treated with conventional dressing). Data were analyzed using Microsoft Excel Spreadsheet, categorical data were expressed as rates, ratios, and percentages, and the comparison was performed using Chi-square test and Fisher's exact test. Results: At the end of week 2, the mean wound area, after the dressing, was significantly less in Group A compared to Group B (P ≤ 0.001). The study also showed lower number of patients with slough/necrotic tissue in Group A than in Group B (P ≤ 0.001). At the end of week 4, no patient with wound discharge was observed in Group A compared to Group B (P = 0.005). Conclusion: The treatment of diabetic foot ulcers with collagen granule resulted in the reduction in wound area, slough/necrotic tissue, and wound discharge, leading to early wound healing compared to conventional dressing.
  5,905 639 -
Efficacy of mulligan's self-sustained natural apophyseal glides in decreasing pain, disability, and improving neck mobility among the nursing professional suffering from work-related neck pain
Shagun Aggarwal, Meenakshi Verma
January-June 2018, 6(1):48-53
Background and Aim: Prevalence of neck pain in nursing professionals (NPs) is much higher than in the general population. However, concrete evidence is not available regarding the efficacy of the therapeutic intervention for treating neck pain among them. The purpose of this study was to compare the efficacy of Mulligan's self-sustained natural apophyseal glides (SNAGs) and conventional physiotherapy in the management of work-related neck pain (WRNP) among the NPs. Materials and Methods: A total of 38 NPs with WRNP were recruited using the simple random sampling (lottery method) to participate in this two group such as pretest–posttest and single-blinded randomized controlled study from recognized tertiary care teaching hospital. Recruited NPs were randomly allocated into two groups such as Group A and Group B. NP in Group A taught self-SNAGs with a towel and instructed to perform 10 repetitions ×1 set/two hour ×4 times/day for 5 days/week ×2 weeks. Whereas in Group B, NPs received conventional physiotherapy treatment, consist of neck isometrics, and performed for 10 s ×10 repetitions ×1 set/day ×5 days/week ×2 weeks. Both groups were asked to use the hot pack for 15 min, before their intervention. Visual Analog Scale (VAS) score, neck disability index (NDI), and cervical range of motion (ROM) were documented at baseline, 2nd-week postintervention, and 4th-week follow-up period and analyzed. Results: Group A revealed statistical significance difference (P < 0.05) in VAS, NDI, and neck ROM when compared to Group B. Conclusion: Mulligan's self-SNAGs have proved to be more beneficial over the conventional physiotherapy in the management of WRNP among the NPs.
  5,607 488 -
Cryptococcus neoformans meningitis in a Non-HIV infected, nonorgan transplant, immunocompromised individual
Sandhya Manorenj, Veeramachaneni Leela Rani, Swathi Suravaram, C Sujana Reddy
January-June 2018, 6(1):139-142
Cryptococcus neoformans is an opportunistic fungus and an important cause of central nervous system infections among immunocompromised individuals, especially in HIV-reactive and organ transplant recipients. Cryptococcal meningitis presenting as the initial manifestation of diabetes is rare in published literature. We present a case of C. neoformans meningitis in a patient with newly diagnosed Type II diabetes mellitus.
  5,115 404 -
The burden of polypharmacy and pattern of comorbidities among chronic kidney disease patients in clinical practice
Olumuyiwa John Fasipe, Peter Ehizokhale Akhideno, Oluwatosin Beatrice Ibiyemi-Fasipe, Ayodeji Adebayo Idowu
January-June 2018, 6(1):40-47
Introduction: The practice of polypharmacy and pattern of associated specific comorbidities/complications among chronic kidney disease (CKD) patients can predispose them to drug-related problems such as drug–drug interactions (DDIs) and adverse drug reactions (ADRs) which may be associated with increased morbidity, mortality, health-care cost, and length and frequency of hospitalization. This can also produce a negative deteriorating and counter-efficient effect on the health and treatment outcome of these patients. Materials and Methods: This was a descriptive, prospective study of 18-month duration that was carried out to review the medical case records of consented adult CKD patients attending a Nigerian tertiary kidney care hospital from January 2015 to June 2016. Results: This study involved 123 consented adult CKD patients comprising 82 (66.67%) males and 41 (33.33%) females, with a mean age of 53.81 ± 16.03 years. The most frequently prescribed medications were furosemide (88, 71.6%), enoxaparin (67, 54.47%), lisinopril (65, 52.9%), oral calcium carbonate (63, 51.2%), α-calcidol (62, 50.4%), and erythropoietin (61, 49.6%). Among these CKD patients, the prevalence of polypharmacy and renal replacement therapy was 85.37% and 56.91%, respectively. Most proportion of the respondents 45 (36.59%) had two number of comorbidities with hypertension (103, 83.70%), diabetes mellitus (39, 31.70%), obesity (24, 19.51%), heart failure (11, 8.90%), obstructive uropathy (8, 6.50%), HIV (7, 5.70%), and stroke (5, 4.10%) being the most frequent. Regarding the form of nephrological interventions being offered: Majority of the respondents, i.e., 66 (53.66%), were on maintenance dialysis, followed by 53 (43.09%) on conservative care and 4 (3.25%) on renal transplantation. Conclusion: The prevalence of polypharmacy is significantly high in these CKD patients. The practice of polypharmacy and pattern of associated specific comorbidities can indeed increase the risk of drug-related problems such as DDIs and ADRs. There is a critical need to minimize the number of prescribed medicines for these patients in order to reduce the associated morbidity, mortality, healthcare costs, and frequency and length (duration) of hospitalization.
  4,879 572 1
Impact of educational intervention on knowledge, attitude, and practice of pharmacovigilance among nurses
Divya Goel
January-June 2018, 6(1):32-35
Introduction: Pharmacovigilance (PV) helps in gathering adverse drug reaction (ADR) data regarding drugs. However, underreporting of ADR is still very high among health-care professional due to lack of knowledge and awareness. Nurses can play a vital role in collection of ADR data. However, at present, we have little data about awareness of PV among nurses in India. This study was planned to know the level of knowledge, awareness, and practice of PV among nurses and subsequent change in these after educational intervention PV session. Materials and Methods: We conducted a cross-sectional descriptive questionnaire-based study among nursing staff of a Tertiary Health Care and Teaching Institute. Nursing staff was given pre-designed descriptive questionnaire. Participants were asked to fill knowledge, attitude, and practice (KAP) questionnaire before and after interactive educational training program. The impact of the educational intervention was evaluated by comparing the pre- and post-intervention questionnaire using Fisher's exact test. Results: A total of 98 participants filled the questionnaires before and after the educational intervention. Educational program on PV was found to statistically increase the correct response regarding knowledge and positive attitudes toward various aspects of PV. Conclusion: The KAP of nurses increased after training program on PV. It increased their level of awareness about principles and techniques of PV. Such educational intervention if held regularly can help in long-term practice of PV.
  4,966 471 3
The clinical assessment of impulsivity
Nagesh Brahmavar Pai, Shae-Leigh Vella, Kerry Dawes
January-June 2018, 6(1):95-98
The term impulsivity is often used to describe behavior that is both spontaneous and detrimental. Impulsivity is multidimensional and derives from personality, general psychopathology as well as specific mental disorders. Thus, the construct of impulsivity is important as it is associated with numerous mental disorders as well as socially deviant behaviors ranging from behaviors targeted towards others such as aggression, to behaviors targeted toward oneself, for example, self-harm and suicide. As a clinical construct impulsivity is highly predictive of poor prognosis thus further emphasizing its clinical relevance. Therefore, the need exists for impulsivity to be clinically assessed and this assessment should take place at the same time as the assessment of risk. As risk and impulsivity are interrelated and interact. Although there are existing self-report rating scales for trait-based impulsivity, a dearth exists in regards to assessment of impulsivity in clinical practice that is focused and pragmatic. Thus, a pragmatic rubric to guide the individualized assessment of impulsivity in a clinical population is proposed. The quadrants espoused will assist both with the formulation of questions and categorization of responses to determine the most appropriate interventions for the client.
  4,923 313 -
Student selection for medicine: Still a “Thorny” issue
Marita Lynagh, Graeme Horton, Balakrishnan (Kichu) Nair, Marjorie Walker, Brian Kelly, David Powis
January-June 2018, 6(1):147-151
Despite the growth in literature and concerted efforts on many fronts to improve the selection process for medicine, there remain a number of contentious issues. Medical schools worldwide need to consider the often disparate priorities of multiple stakeholders when selecting students. They seek to recruit students who are likely not only to succeed in their program but also need to meet their own and often their government's agenda to meet equity and workforce targets. Academic performance prior to medical school predicts academic success at medical schools and beyond, but if weighed too heavily will restrict access to disadvantaged groups. This article outlines the various components of medical student selection and describes the different contexts in which they are used. We aim for this to be an informative article for reference as medical school selection committees worldwide constantly evaluate whether admissions processes are fulfilling their criteria. Discussion among medical schools must surely improve efficiency and cross-cultural understanding in the global medical education environment to provide suitable doctors needed for the 21st century.
  4,265 422 3
Revalidation or recertification: What does it all mean?
Robert Pickles
January-June 2018, 6(1):12-15
  4,242 433 -
Weyers acrofacial dysostosis (Curry-Hall Syndrome): Report of a rare case
Suchetana Goswami
January-June 2018, 6(1):143-146
Weyers acrofacial dysostosis (Curry-Hall syndrome) is a rare autosomal dominant skeletal dysplasia manifest by nail dystrophy, oral and dental anomalies, polydactyly of the hands and feet, and mild short stature. We report an 11-year-old boy who presented with onychodystrophy, supernumerary tooth, hypodontia or agenesis of teeth, hyperplastic labial frenulum, polydactyly of the hands and feet, and mild short stature. There was dystrophy of the nail plates of the great toes of both feet. The other nail plates were also affected to a lesser degree, and the toenails are more severely affected than the fingernails. According to her mother, the child's dystrophic nails were present since birth. Examination of his scalp showed normal hair quantity, quality, and structure. There was no history of sweat gland dysfunction. The clinical findings of our patient are consistent with the features of Weyers acrofacial dysostosis.
  4,336 250 1
The need for indian physiotherapy research publications: Understanding journalology and predatory journals
Asir John Samuel
January-June 2018, 6(1):189-191
Publishing a scientific paper can result in fruitful new scientific collaborations, and researchers, including the physiotherapists, and get recognition. The basis of publications is to create a public record of original contributions to knowledge, to encourage scientists to “speak” directly to one another, and to disseminate generated knowledge. This brief communications underlines the nuances of publication and journalology especially to get 'taught' on the principles of academic and scholarly publication, and not to get 'caught' with the pseudo-academics of 'predatory' journal publishing.
  4,265 307 -
Suicidality in somatization and undifferentiated somatoform disorders: A hospital-based study
Manoj Shettar, Anil Kakunje, Ravichandra Karkal, Rohan Dilip Mendonsa, Ganesh Kini, VV Mohan Chandran
January-June 2018, 6(1):36-39
Aim: The aim of this study is to examine suicidality in patients with somatization and undifferentiated somatoform disorders. Materials and Methods: Suicidality was assessed among 105 consecutive patients diagnosed with somatization disorder or undifferentiated somatoform disorder according to the ICD-10 criteria. The Mini-International Neuropsychiatric Interview-Plus and the Columbia-Suicide Severity Rating Scale were used in the study. Results: In the study sample, 68.6% reported wish to be dead, 37.1% reported of nonspecific active suicidal thoughts, and 1.9% reported active suicidal ideation with specific plan and intent. The most frequent reason for suicidal ideation was to end or stop the pain. Conclusion: This study had revealed that somatization and undifferentiated somatoform disorders have a high risk of self-harm.
  4,012 317 1
Yoga therapy for sustained attention
V Vineetha, S Vinutha, K Karthiyanee, A Kumar, HR Nagendra, Tikhe Sham Ganpat
January-June 2018, 6(1):70-72
Background: Sustained attention (SA) is a vital function mediated by the right frontal-parietal cortex. The six letter cancellation task (SLCT) measures SA. Assessment of SA in volunteers undergoing Yoga therapy (YT) training compared to control group is the theme of the present study. Materials and Methods: Sixty healthy volunteers, 48.75 ± 3.86 years of mean age were participated in the present study. Thirty volunteers selected from Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, India were practiced YT for 7 days. They were compared with a control group of 30 healthy volunteers from Sri Devaraj Urs Medical College, Kolar, India matched for the duration of the study, age, gender, and socioeconomic background that were not exposed to YT training but continued their usual college routine during that period. All volunteers were assessed for SA using SLCT. Results: The YT group showed 18.06% significant increase (P = 0.010, paired samples t-test) in total attempted (TA) score on SLCT. Similarly, there was 19.03% significant increase (P = 0.008, paired samples t-test) in net score (NS). However, there was 26.32% decrease in wrongly attempted (WA) score which was statistically not significant (P = 0.637, paired samples t-test). There was no significant change in control group. Increase in TA and NS and decrease in WA is related with enhancement of SA. Conclusion: The results suggest that YT enhances SA in healthy volunteers. Additional well-designed trial with long-term follow-up is needed before a strong recommendation can be made.
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The educational challenge of End-of-Life conversations for our junior doctors
Josephine Suzanne Thomas, Telena Ann Eastley
January-June 2018, 6(1):152-156
Background: In current medical practice we face an increasing array of possible medical interventions, multi-morbid patients and an ageing population. End-of-life (EOL) conversations are key to navigating this complex landscape and ensuring that our patients receive the care most appropriate for their needs. The Challenges: The emotive nature of this topic is well recognised and uncertainties of diagnosis and prognosis can add to the difficulties of these discussions. Junior doctors face some specific challenges in acquiring and practising the necessary skills for EOL conversations in the workplace. Their educational needs are discussed in this article. Educational approach: The educational needs of junior doctors include provision of appropriate resources and reflection on experiences. A coaching style of supervision, with recognition of their skills and support for experiential learning facilitates ongoing development.
  3,476 249 -
Dehiscent mastoid segment of the facial nerve
A Rajeshwary, MK Goutham, K S. Gangadhara Somayaji
January-June 2018, 6(1):187-188
Course of the facial nerve through the temporal bone is known for variations, the commonest being dehiscence of the bony fallopian canal. It is common to have dehiscence of the horizontal tympanic segment; however, complete dehiscence of the vertical mastoid segment is very rare. Here is the report of one such case as a teaching image.
  3,364 233 -
Ocular complications of lamellar ichthyosis
Ibrahim Aliyu
January-June 2018, 6(1):134-135
Ichthyosis is a rare heterogeneous cutaneous disorder characterized by hyperkeratinization of the skin. They may be inherited or acquired following malnutrition, malignancy, or autoimmune disorders. Common forms of ichthyosis include lamellar ichthyosis (LI), X-linked ichthyosis, bullous ichthyosiform erythroderma, and ichthyosis vulgaris. LI may be associated with ectropion and eclabion and if poorly managed could result in vision loss. The case of a 7-month-old girl who presented with bilateral keratitis, panophthalmitis, and perforated right cornea is reported in this communication.
  3,344 213 -
Cytological, histopathological and immunohistochemical features of merkel cell carcinoma- A case report
Pooja Chauhan, Neelam Gupta, Kavita Mardi, Sudershan Kumar Sharma, Anita Negi
January-June 2018, 6(1):122-125
Merkel cell carcinoma (MCC) is a rare, potentially aggressive primary cutaneous neuroendocrine carcinoma. MCC commonly occurs on sun-exposed skin in fair-skinned elderly individuals. It usually presents as a banal-appearing lesion, and the diagnosis is rarely suspected at the time of biopsy. We describe the cytomorphologic, histopathological, and immunohistochemical characteristics of MCC in a 76-year-old male patient presenting with rapidly evolving large red raised lesion over cheek for 1 month. Cytohistopathological evaluation suggested MCC. Immunohistochemistry revealed that the tumor cells were negative for leukocyte common antigen, S-100 protein, HMB45, and cytokeratin 20 and positive for neuron specific enolase. Because of the documented aggressiveness and rising incidence, early diagnosis of this rare tumor is necessary for the management of MCC.
  3,206 232 2
Gossypiboma: A diagnosis not to forget
Shreyas Sorake, Charvi Chawla, J Prasanna Kumar Rao, Raghavendra Kini, Joji Peter
January-June 2018, 6(1):130-133
Granuloma formation is a specific type of chronic inflammation initiated by infectious and noninfectious agents with an aggregation of multinucleated giant cells. Foreign bodies can penetrate soft tissues in connection with accidents through open wounds and lacerations. Foreign body giant cells are most commonly observed at the tissue interface where the size of foreign particulate is too large to permit macrophage phagocytosis. A case of foreign body granuloma in the mandible is presented.
  3,004 221 1
Xanthogranulomatous appendicitis: Entity of surprise
Anindya Adhikari, Rudra Narayan Ray, Raison Shail Minz, Bidhan Chandra Nayek
January-June 2018, 6(1):120-121
Xanthogranulomatous inflammation is a special type of inflammatory process with unknown etiology. Commonly involved organs are gallbladder and kidney. So far, only a negligible number of cases of xanthogranulomatous appendicitis (XA) have been reported in different literatures. Herein, we report a case of XA in a 49-year-old female patient, who presented with recurrent right iliac fossa pain. Clinically, appendicitis was diagnosed and appendectomy was performed. Histopathological examination revealed it as a case of XA. No other form of treatment was given and the patient is doing well 1 month postoperatively.
  2,914 217 1
Unusual case of immunoglobulin G4-related disease
Prijesh Janardanan, IK Biju, Remesh Bhasi
January-June 2018, 6(1):136-138
Immunoglobulin G4-related disease is a group of disorders, which was thought to be unrelated at first and now grouped together due to their common characteristics. This case is being reported for its unique presentation, rarity, difficulty in diagnosis, and recognition of the existence of the disease entity in this part of the world.
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Unusual finding in scalp swelling: Microfilaria in fine-needle aspiration and trichilemmal cyst in histopathology
Rashmi Patnayak, Mohita Ray, Amitabh Jena
January-June 2018, 6(1):192-193
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