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  Citation statistics : Table of Contents
   2019| July-December  | Volume 7 | Issue 2  
    Online since December 16, 2019

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A theoretical review of psychological resilience: Defining resilience and resilience research over the decades
Shae-Leigh Cynthia Vella, Nagesh B Pai
July-December 2019, 7(2):233-239
Recent times have seen a shift in interest from a focus upon the deficits of individuals to a focus upon individual's strengths. Resilience is a positive psychology construct that has been investigated for decades, prior to this paradigm shift. This article reviews definitions of resilience over time. Although there is no single agreed definition; resilience is commonly described as the ability to bounce back. The risk of stress and negative life events in triggering mental illness has long been recognized. Similarly, the positive outcomes of some individuals to highly adverse situations have also been of interest for a long time. These positive responses or outcomes in the face of significant risk or adversity are generally known as resilience. This article provides a review of definitions of resilience and resilience related phenomena as well as a historical review of the focus of resilience research across the decades in order to inform future research and theorizing. The article concludes with recommendations to researchers to explicitly define their definition and conceptualization of the construct as well as the imperative to move towards a unified view of the construct of resilience. Further, it is clear that research on resilience has progressed and evolved over the decades however this does not denote that research in the area is complete. As such researchers should still seek to understand the complexities of resilience, how to build resilience in different populations, or in individuals experiencing similar adversities.
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Utility of concept mapping as a tool to enhance metacognitive teaching and learning of complex concepts in undergraduate medical education
Aye Aye Khine, Anthonio Oladele Adefuye, Jamiu Busari
July-December 2019, 7(2):267-272
The inherent complexity in the nature of medical practice necessitates that medical practitioners have to be equipped with a sound foundation in their knowledge as well as in their ability to think, act, reflect, evaluate, and synthesize thoughts at the metacognitive level. Furthermore, medical students are required to learn meaningfully and become lifelong learners. Prior study has shown that medical students struggle to learn and understand complex concepts in the curriculum. Metacognitive skillfulness has been reported to influence the achievement of deeper understanding and promote transition from a dependent learning state to that of self-directed learner. Concept mapping (CM) is an example of such a metacognitive strategy that can promote meaningful learning through advanced critical thinking and improved reasoning in students. We believe that CM is an effective educational strategy that can be used to teach complex concepts in medical education and provide a proposal on how to effectively incorporate CM into a teaching curriculum for medical students.
  4 3,267 322
Epilepsy surgery in India
George C Vilanilam
July-December 2019, 7(2):287-292
The history of epilepsy surgery dates back to the era before computerized tomography, magnetic resonance imaging (MRI), positronemission tomogram imaging, and electroencephalogram (EEG). Victor Horsley's resection of a cortical scar in 1886, based purely on localization is considered as the first epilepsy surgery recorded in history. In India, Prof. Jacob Chandy performed a pediatric hemispherotomy in 1952 at the Christian Medical College, Vellore. Prof. Malla Bhaskar Rao did a cortico-amygdalohippocampectomy in 1995 for hippocampal sclerosis at Sree Chitra Institute, Trivandrum. With over 1 million patients suitable for epilepsy surgery in India, the burden of disease is alarmingly high. The spectrum of epilepsy surgery resections in India has expanded tremendously over the past decade, but the centers performing them are few and far in between. Hence, the “surgical gap” (which includes eligible patients awaiting surgery) is ever increasing. With just around 1000 procedures performed every year, the surgical epilepsy programs in India need a massive overhaul in terms of skilled workforce and infrastructure. Sophisticated presurgical workup modalities, such as MEG, stereo-EEG, EEGfunctional MRI, etc., are have already been popularized in India. The results of epilepsy surgery in India are also at par with the world's state-of-art centers. As medical and surgical epileptology grows further over the years in India, the surgical treatment gap hopes to be effectively addressed.
  2 2,697 188
Peripheral blood level of natural killer cells in pregnant women with recurrent spontaneous abortion during the 6–12 weeks gestation
Sung-Guk Kim, Mi-Yong Paek, Il Gyong Ko
July-December 2019, 7(2):191-194
Background and Aim: The study was performed to confirm the clinical characteristics and peripheral blood level of natural killer (NK) cells as a diagnostic index in women with recurrent spontaneous abortion (RSA) comparing with normal pregnant women. Materials and Methods: Consultation with all patients was conducted to obtain the number and timing of previous miscarriages and signs and symptoms of abortion progress. Assessment of peripheral blood NK cell level was performed by flowcytometric analyses. Results: Women with RSA have brown-colored vaginal bleeding and history of more than three consecutive miscarriage, while the percentage of peripheral blood NK cell within blood lymphocytes was more than 18.1%. Conclusion: In the current study, RSA patients (6–12 weeks') showed significantly higher level of peripheral blood NK cells (>18.1%) compared to that of normal gravidas. Further studies are required to clarify the precise mechanism how NK cells affect the progression of healthy pregnancy and investigate clinical evidence whether therapies to lower the level of NK cells can decrease the rate of RSA.
  2 2,446 211
Georges Gilles de la Tourette and his legacy
Andrea E Cavanna, Stefano Seri
July-December 2019, 7(2):303-308
The first comprehensive description of Gilles de la Tourette syndrome as a neurological condition dates back to 1885 when Georges Gilles de la Tourette (1857–1904) published his case series of nine patients sharing the clinical triad of tics, echolalia, and coprolalia. At the time, Gilles de la Tourette was working at the Salpêtrière Hospital in Paris, France, under the guidance of Jean-Martin Charcot (1825–1893), one of the fathers of modern neurology. It was in fact Charcot who credited Gilles de la Tourette with the description of the syndrome that was named after him and gave him eponymous fame. Gilles de la Tourette's character was described as talented but erratic, and his life was relatively short for current standards but far from uneventful. Gilles de la Tourette syndrome, the complex neurodevelopmental disorder characterized by multiple motor and vocal tics, is undoubtedly his main legacy. The importance of the 1885 article was greatly underestimated at the time of its publication, partly because Gilles de la Tourette's main interests lied in the field of hysteria and hypnosis. Throughout the first half of the XX century, his name was progressively neglected, as the psychoanalytic paradigm that prevailed associated tics with rare and somewhat bizarre psychologically driven manifestations. However, Gilles de la Tourette's posthumous fame resurged during the 1960s, concomitant to a paradigm shift whereby the development of neurobiological models drove the renaissance of the scientific study of tic disorders, together with a reappraisal of Gilles de la Tourette's initial contribution.
  1 4,750 256
Laryngeal manifestation due to smoking among the pediatric age group – Our experiences at an Indian teaching hospital
Santosh Kumar Swain, Ishwar Chandra Behera, Jatindra Nath Mohanty
July-December 2019, 7(2):186-190
Background and Aim: Smoking among the pediatric age group is a public health concern. It has direct link to laryngeal manifestations. Due to increased exposure to smoking, it is affecting the children directly or indirectly through involving upper airway, particularly the larynx. In this study, we explored the effect of cigarette smoking in laryngeal manifestations among the pediatric age group. Materials and Methods: It is a retrospective study conducted at a tertiary care teaching hospital of eastern India between December 2017 and June 2019. There were 112 pediatric patients between the age of 5 and 16 years with complaints of hoarseness of voice. Out of 112, 32 (28.57%) had history of exposure to cigarette smoking. All the children of this study underwent a careful and detailed general and physical examinations and local examinations such as the ear, nose, and throat. All the children were also subjected to videolaryngoscopy for the assessment of the larynx. Results: The majority of the children with smoking habit were male (59.37%). The most common diagnosis among children with smoking habit was laryngopharyngeal reflux (LPR) (40.62%) followed by chronic laryngitis (25%), vocal fold keratosis (18.75%), Reinke's edema (12.50%), and malignancy (3.12%). All these laryngeal lesions were treated appropriately. LPR and chronic laryngitis were treated with conservative medications and speech therapy. Vocal fold keratosis and Reinke's edema were treated with microlaryngeal surgery and conservative treatment. Conclusion: Smoking has adverse effect on the larynx in the pediatric age group. It has an impact to alter the structural changes in the vocal folds. Speech therapy, vocal hygiene, and absolute cessation of the smoking are ideal treatment for pediatric dysphonia due to the effect of smoking.
  1 2,911 184
Profile of nutritional anemia and its correlation with serum iron, Vitamin B12, and folic acid level among the tribal population of northern districts of West Bengal, India
Ankita Dhanuka, Bidyut Krishna Goswami, Sarama Banerjee Goswami, Sudipta Chakrabarti
July-December 2019, 7(2):201-205
Background and Objective: Nutritional anemia is the most common and easily preventable cause of anemia. No comprehensive data regarding the magnitude of this problem are available in the literature in northern regions of West Bengal where a significant number of tribals inhabit. The present study was undertaken to assess the magnitude of anemia and the status of iron, Vitamin B12, and folic acid deficiency in tribals of North Bengal and to analyze their red blood cell (RBC) morphology. Materials and Methods: A descriptive study done on the individuals during a period of 1 year at North Bengal Medical College. Serum iron, ferritin, total iron-binding capacity, Vitamin B12, and folic acid were measured along with other relevant investigations. Results: Forty-eight out of 88 (54.51%) of the cases were found to be anemic. Thirty-four out of 48 (70.83%) of them had at least one of the nutritional deficiencies. Iron deficiency was most common, seen in 18 (37.5%) of cases. Abnormal hemoglobin was seen in 7 (14.58%), two of which also had nutritional deficiency. In combined iron and folate deficiency, 7 out of 10 (70%) showed microcytic hypochromic morphology and 3 (30%) were dimorphic. Conclusion: Iron and folic acid deficiency is quite common among the tribals of northern region of West Bengal. RBC morphology alone lacks the specificity for the diagnosis of causes. Furthermore, nutritional deficiencies may coexist with abnormal hemoglobin variants, complicating their diagnosis further. A proper clinical, hematological, and biochemical correlation is required for the accurate diagnosis and effective treatment of anemia, highlighting the need for a screening for the causes of anemia in this population.
  1 3,366 356
Does Thyroid dysfunction correlates with iron overload in Eβ thalassemia patients? A study from a tertiary care thalassemia center in India
Shuvraneel Baul, Tuphan Kanti Dolai, Pranab Kumar Sahana, Rajib De, Prakas Kumar Mandal, Prantar Chakrabarti
July-December 2019, 7(2):206-211
Background and Aim: Large number of Haemoglobin E-beta thalassaemia (Hb E/β-thalassaemia) patients show iron overloads and related end-organ damage irrespective of transfusion requirements. The prevalence of hypothyroidism in Indian population is approximately 11%. We studied the relationship between thyroid dysfunction and iron overload in Hb E/β-thalassaemia. Materials and Methods: The study included Eβ-thalassemia patients above the age of 10 years. Patient's serum ferritin level evaluated for the evaluation of iron status and thyroid-stimulating hormone, FT4, T3 for thyroid function status. Results: The study was conducted from January 2016 to December 2017. Of 50 Eβ-thalassemia patients, there were 22 females; the mean age was 19 years (range: 12–47 years). A total of 22 (44%) patients showed thyroid dysfunction; overt hypothyroidism seen in 6 (12%) patients with mean ferritin level of 1077 ng/ml and subclinical hypothyroidism seen in 16 (32%) patients with mean ferritin level of 1200 ng/ml. Normal thyroid function seen in 28 (56%) of patients with mean ferritin level of 1155 ng/ml. Conclusion: The prevalence of thyroid dysfunction was found to be higher in Hb E/β-thalassaemia patients, but a definite correlation with the serum ferritin level could not be established.
  1 4,122 281
Effect of exposure to formaldehyde on the forced vital capacity of medical students: A longitudinal study
Dipak Kumar Dhar, Sudeepa Chaudhuri
July-December 2019, 7(2):212-216
Background and Aim: Formaldehyde exposure is one of the various occupational hazards experienced by a doctor during his life. There is consistent and regular exposure to formaldehyde during the gross anatomy dissection classes. Since it vaporizes at room temperature, respiratory system is easily affected. The present study was undertaken to assess its effect on forced vital capacity (FVC) of medical students. The aim of this study is to evaluate the FVC of the 1st year medical students after exposure to formaldehyde. Materials and Methods: A longitudinal study was conducted in the Department of Physiology among 1st year MBBS students. The spirometric parameter FVC was recorded in 80 medical students using spirometer RMS Helios 401. Percent predicated values were used for analysis. The baseline values were recorded at the beginning of the academic calendar and followed up at the end of 1st, 6th, and 10th months. Data were analyzed using the SPSS. Descriptive statistics and repeated measures ANOVA was used for the analysis. A value of P < 0.05 was considered statistically significant. Results: The mean FVC declined significantly over the 1st month of exposure following which there was a gradual reversion to the baseline values over the remaining study period. The cumulative pattern of this change was also statistically significant (P = 0.000). Conclusion: Formaldehyde causes detrimental changes on the ventilatory mechanics of the lung. The effect is marked in the initial phase following which the body tries to restore homeostasis.
  1 2,169 193
Prevalence and distribution of dental agenesis among orthodontic patients of Kathmandu, Nepal
Sanjay Prasad Gupta, Shristi Rauniyar
July-December 2019, 7(2):172-176
Background: Tooth agenesis is the most common developmental dental anomaly in humans with a wide variability of distribution among different population. Objective: The objective of this study was to find out the prevalence of dental agenesis among Nepalese orthodontic patients of Kathmandu and its occurrence with relation to gender, sides, and jaw. Materials and Methods: This study consisted of 601 patients (242 males and 359 females) aged between 10 and 35 years who require orthodontic treatment. Dental panoramic radiographs were evaluated for dental anomalies causing disturbance in number by a trained observer who followed a preestablished protocol. Chi-square test was used to determine the difference in the prevalence of dental agenesis between genders, sides, and jaws. Results: The prevalence of dental agenesis was 7.48% (45) while excluding the third molar and 27.62% (166) while including the third molar. The prevalence of oligodontia was 0.33% (2). The total number of missing teeth including the third molar was 371 and it was 72 while excluding the third molar. Maxillary lateral incisor was the most lost (48.61%) followed by mandibular lateral incisor (19.44%), mandibular central incisor (8.33%), mandibular second premolar (6.94%), and maxillary second premolar (5.55%) while excluding the third molars. There was no statistically significant difference in the prevalence of missing teeth in between gender (P = 0.996), in between right and left sides (P = 0.590), and in between upper and lower jaws (P = 0.010). Conclusion: The most common missing teeth were maxillary lateral incisor followed by mandibular lateral incisor, mandibular central incisor, and mandibular second premolar. Orthodontists have the responsibility to observe each patient carefully for dental agenesis and have full knowledge to plan the best possible treatments.
  1 2,524 229
Cyberchondria: Implications of online behavior and health anxiety as determinants
Denelle Mohammed, Sara Wilcox, Camille Renee, Christine Janke, Niki Jarrett, Anjelika Evangelopoulos, Chasity Serrano, Nazmin Tabassum, Natashia Turner, Melody Theodore, Aleksandar Dusic, Rana Zeine
July-December 2019, 7(2):154-162
Background: Cyberchondria is excessive worrying about one's health that develops following internet search for medical and health information. Aim: This study investigates how the development of cyberchondria relates to characteristics of the person searching the internet including their medical history, age, and health-related anxiety. Materials and Methods: A cross-sectional survey was conducted between 2015 and 2016. The “Dr. Net” survey consisted of 32 questions based on previously published surveys probing the use of internet search for health-related information. Participants were recruited from the authors' own social network by receiving a hyperlink through social media platforms and e-mails. One hundred and ninety-one English-speaking individuals, majority from Canada and the USA, completed the “Dr. Net” questionnaire online and anonymously through SurveyMonkey®. Results: Females sought health-care advice earlier than males (**P = 0.005). Younger age groups exhibited higher frequencies of internet search, daily versus weekly, versus monthly versus yearly, with differences between the 21 and 30 versus >60 (***P = 0.000), 21–30 versus 51–60 (**P = 0.011), 21–30 versus 31–40 (**P = 0.019), 31–40 versus 51–60 (**P = 0.012), 41–50 versus 51–60 (**P = 0.021), and <20 versus >60 years' age groups (**P = 0.024). 30.7% reported developing cyberchondria. Indicators of cyberchondria correlated with older age (r = 0.154, P=**0.036), negative medical history (r = 0.191, **P = 0.013), health anxiety (r = 0.268, ***P = 0.000), and hypochondria (r = 0.142, P = 0.062). Less than four percent perceived their internet search as disadvantageous. Conclusion: Cyberchondria was reported by a third of those who conducted health-related internet searches, with higher frequencies in older, previously healthy individuals who had health anxiety.
  1 16,258 781
Moyamoya disease
Girish Menon, Ajay Hegde
July-December 2019, 7(2):224-232
Moyamoya disease (MMD) is a unique cerebrovascular disease characterized initially by an obliterative vasculopathy followed by a compensatory proliferative vasculopathy. Coined by Suzuki and Takaku in 1969, the term moyamoya (MM) refers to a “puff of smoke” like appearance of small collaterals seen traversing the basal ganglia and thalamus, in response to progressive stenosis and occlusion of supraclinoid internal carotid artery. The natural history is unclear but is generally one of the gradual progressions. The etiopathogenesis of MMD is unknown, but the syndromic form may be associated with certain genetic conditions, such as Down's syndrome and neurofibromatosis, and may occur following cranial radiation. The clinical manifestations are predominantly ischemic and usually confined to the anterior circulation. Hemorrhagic presentation is less common and occurs more often in adults. Similarly, posterior circulation may get involved in later stages. Treatment is essentially surgical, and a combined revascularization strategy involving a direct superficial temporal artery to middle cerebral artery anastomosis along with a pial synangiosis provides a reasonable stroke-free survival. Considerable controversy exists on the etiopathogensis, diagnostic guidelines, management protocols, ideal surgical approach, and the role of surgery in hemorrhagic MMD. This review attempts to summarize the current advances of MMD on the aspects of epidemiology, etiology, clinical features, imaging diagnosis, and treatment.
  1 3,394 328
Gilles de la Tourette syndrome: An overview
Andrea Nani, Andrea E Cavanna
July-December 2019, 7(2):277-283
Gilles de la Tourette syndrome (GTS) is a neurodevelopmental condition characterized by multiple motor and vocal tics with a chronic course. With its multifaceted range of symptoms, GTS lies at the crossroads of neurology and psychiatry. This review article provides an outline of GTS, encompassing its extended clinical phenomenology, pathophysiology, and treatment options. Tics are the most common hyperkinetic manifestations in childhood, and the majority of patients present with comorbid behavioral conditions, such as obsessive-compulsive disorder, attention-deficit hyperactivity disorder, anxiety, and affective symptoms. Most patients report that their tics are preceded by sensory experiences (premonitory urges), i.e., unpleasant sensations characterized by pressure, tension, tightness, pain, itch, or vague inner discomfort. Tics can be temporarily suppressed and delayed for seconds to minutes, at the expense of mounting inner tension until the subjective feeling becomes unbearable, and the tic must be released. A better understanding of the mechanisms at the root of tic production can pave the way to the development of more effective treatment interventions for patients with GTS in order to improve their health-related quality of life (QOL). Specific instruments for measuring health-related QOL based on standardized assessments allow to appraise the impact of both tics and behavioral comorbidities and tailor treatment strategies to individual patients.
  1 3,664 318
Radicular lingual groove: A contributory factor in periodontal pathology
Gaurav Didhra, Jagjit Singh, Rajan Gupta, Parveen Dahiya
July-December 2019, 7(2):240-242
Radicular gingival groove is a developmental anomaly most commonly occurring in the maxillary anterior teeth that acts as a hidden trap in the tooth which accumulates plaque and periodontal pathogens, leading to the formation of periodontal pocket with or without pulpal involvement. The diagnosis of these grooves in terms of radiographic images is very difficult to predict and can only be appreciated as per patient's chief complaint along with clinical examination of periodontal pocket depth with probing and endodontic treatment of tooth if pulpal involvement is present.
  - 3,255 196
Fabrication of modified palatal augmentation prosthesis to improve functional deficits in postglossectomy and mandibulectomy patient
Kathleen Manuela DíSouza, Meena Ajay Aras
July-December 2019, 7(2):243-247
Squamous cell carcinoma of tongue is commonly associated with infiltration of disease into the floor of mouth and the mandible, requiring extensive ablative surgery of the tongue and the mandibular bone. This gives rise to severe facial disfigurement along with various functional deficits, such as difficulty in swallowing, mastication, and speech; uncontrolled salivary secretions; altered mandibular movements; and occlusion. This article describes the prosthetic rehabilitation of a patient who has undergone partial glossectomy with segmental mandibulectomy. It involves the fabrication of a hollow palatal augmentation prosthesis with a widened occlusal table on the nonresected side and a palatal-based guidance ramp for the mandible on the resected side. This case report presents an alternative method to rehabilitate such partially edentulous patients with compromised anatomical situation.
  - 961 14
Swyer syndrome (46XY pure gonadal dysgenesis) presenting with dysgerminoma
M Banyameen Iqbal, Iqra Mushtaq, Tushar Kambale, Indranil Dey
July-December 2019, 7(2):248-250
Dysgerminoma is the most common malignant germ cell tumor of the ovary. This malignancy can be associated with pure gonadal dysgenesis (Swyer syndrome), mixed gonadal dysgenesis, and partial gonadal dysgenesis. Dysgerminoma usually develops in phenotypic females with 46XY pure gonadal dysgenesis. This patient presented with an abdominopelvic mass. Laparotomy was done. 46XY karyotype was detected by lymphocyte culture. The patient underwent gonadectomy, and histopathological results were streak ovaries with dysgerminoma. Five percent of dysgerminomas are discovered in phenotypic female and 46XY karyotype; thus, in an adolescent with dysgerminomas and amenorrhea, karyotyping should be done.
  - 2,708 199
Chronic sclerosing osteomyelitis: A case report on a rare complication of tooth extraction
Valen Dela Dísouza, Elvita Martis, Kora Ramya Reddy, Prasanna Kumar Rao, Ritesh KB, Raghavendra Kini, Suraj Hegde
July-December 2019, 7(2):251-253
Chronic osteomyelitis can be a protracted disease often caused by inadequate curettage, injudicious use of antibiotics, and unnecessary delay in treating infected teeth. Failure of treatment of the odontogenic infection may result in decreased vascularization of the affected tissues, walling-off the infected area by relative avascular tissue, the formation of sequestra or reactive sclerosis of the bone. Here, we report a case of sclerosing type of osteomyelitis with periosteal reaction as seen in a middle-aged woman, highlighting how inadequate curettage following a common procedure such as extraction could lead to an uncommon complication.
  - 5,998 12
Ophthalmological perspectives of toxic epidermal necrolysis
Gayatree Mohanty, Shovna Dash, Manoj Kumar, Devanshi Desai
July-December 2019, 7(2):254-257
Toxic epidermal necrolysis (TEN) is as rare as two cases per million per year, but the ocular manifestations and sequelae are very severe. We present a case series of seven patients admitted to the intensive care unit in a tertiary hospital with a diagnosis of TEN describing the extent of ocular involvement, its response to treatment, and appearance of sequelae. All seven were drug-induced with moderate-to-severe skin, mucosal, ophthalmic involvement, and systemic involvement. Ocular findings on presentation were eyelid skin detachment, adherent lid margins, bilateral mucopurulent conjunctivitis with inflammatory membranes, and punctate epithelial keratitis in all patients. Large persistent corneal epithelial defect was seen in four patients. On follow-up, five had severe keratoconjunctivitis sicca and entropion with trichiasis. Photophobia was the major debilitating sequelae. Early management was the key to reduce severity, cicatrization, and sequelae. Corticosteroids topically and systemically, topical cyclosporine, and lubricants were the mainstay of management.
  - 2,025 169
Vascular malformation of the upper lip
Imran Mohtesham, Chethana Pillappa, Priyal Rohan
July-December 2019, 7(2):258-261
Vascular anomalies account as one among the most difficult diagnostic and therapeutic enigmas that can be encountered in the practice of medicine. These lesions are the result of an embryonic abnormality of the vascular system. The main characteristic feature of vascular malformations is that they never show the signs of involution. It is the most common neoplasm of the infancy. The clinical presentations are extremely protean and can range from an asymptomatic birthmark to life-threatening hemorrhage. Here, we present a case of vascular malformation in the upper lip of a 4-year-old patient.
  - 2,288 180
Giant cell tumor tendon sheath at inguinal region masquerading as enlarged lymph node
Minakshi Chouhan, Sheetal Arora, Neetika Gupta, Rashmi Arora
July-December 2019, 7(2):262-264
Giant cell tumor of the tendon sheath (GCTTS) is a benign tumor and is the second most common tumor of the hand after ganglion cysts. It is a slow-growing benign lesion of the soft tissues. The etiology of GCTTS is not clear. Although GCTTS most commonly presents in a digit of the hand, it may also present in the palm, wrist, foot, knee, ankle, elbow, or hip. Here, we present a rare case of GCTTS originating at the inguinal region, which has not been previously reported. A 52-year-old male presented with a 2 cm × 1 cm swelling at the right inguinal region. The clinical impression was inguinal lymph node enlargement. Ultrasonography (USG) showed the presence of large inguinal lymph node. Fine-needle aspiration cytology (FNAC) showed the features suggestive of giant cell lesion, possibly GCTTS. Repeat ultrasound revealed a large oblong-shaped hypoechoic lesion with mild internal vascularity in the right inguinal region above the external oblique aponeurosis, suggestive of aponeurotic giant cell tumor. Histopathology was confirmatory. Here, we report this case to highlight the role of FNAC in diagnosing GCTTS at a rare site, i.e., inguinal region. Due to its location at inguinal region, along with clinical suspicion of tubercular lymphadenitis and USG findings showing large inguinal lymph node in the right inguinal area, it needs to be differentiated from other causes of lymph node enlargement. It would be prudent to state that FNAC along with radiology can help reach the final diagnosis.
  - 2,249 149
Scientistic reductionism and the “dark side” of modern medicine: A personal reflection
Bhaskara P Shelley
July-December 2019, 7(2):139-150
  - 7,636 721
Suicide: Some innovative trends, breakthroughs, and challenges ahead
Nagesh Brahmavar Pai
July-December 2019, 7(2):151-153
  - 2,401 316
Airway concerns in a neonate with Treacher Collins syndrome posted for tracheoesophageal fistula repair
Sushama Raghunath Tandale, Yogesh Gavali, Subhadra Sinha, Chandraprabhu Birnale
July-December 2019, 7(2):319-320
  - 1,865 132
Propofol-compatible plastics or plastic-compatible propofol?
Varun Suresh
July-December 2019, 7(2):321-322
  - 2,076 212
Fourth Industrial revolution and health professions education
Ajay Telang
July-December 2019, 7(2):265-266
Fourth Industrial Revolution (4IR) described as the biggest change that has begun, is blurring the lines between the physical, digital, and biological spheres. Its fundamentals are Artificial intelligence (AI), cloud computing, internet of things (IoT), and big data analytics. This paper presents the impact, challenges and the way forward for Health Professions Education(HPE) to adapt to 4IR.
  - 2,807 280
Translating research and evidence into practice: Understanding the influencing factors
Elizabeth M Wooster
July-December 2019, 7(2):273-276
As the education continuum moves toward a competency-based format, there is also a movement toward the need to translate research and evidence into clinical and academic practice. While there has been much written about the theoretical basis of knowledge translation, significantly less exists about the practical aspects surrounding this. This article will examine the practical and theoretical basis for using research and evidence to inform clinical and academic practice. It will begin by developing a working definition of research, evidence, and practice. Theoretical basis and its role in translation will then be discussed. The article will finish by discussing practical tips for implementing research and evidence into practice.
  - 1,946 166
Past and current concepts of “Anti-Psychiatry”: Does it have a future?
Krishnamurthy Kavirayni
July-December 2019, 7(2):284-286
Anti psychiatry can better be called Anti Establishment Psychiatry has been propounded be cause of the differences it had with the establishment of Psychiatry of those days for lack of humanitarian approach and not considering the social causation, and leaning so much on somatic treatments whose mode of action is questionable. Unlike Scientology which meant abolition of Psychiatry as a speciality , the anti Psychiatry movement envisaged only reforms in approach to a Psychiatry patient.
  - 7,019 579
History of acne vulgaris and topical drugs in Unani medicine
Shabnam Ansari
July-December 2019, 7(2):293-297
Acne is a common skin disorder that affects both adolescents and adults. Acne vulgaris affects about 85% of teenagers and may continue to adulthood. There are about two million visits to physicians per year for teenagers and the direct cost of acne treatment in the US exceeds $1 billion per year. Psychological, social, and emotional impairments that result from acne have been estimated to be equal and in some instances higher than that of diabetes, arthritis, epilepsy, and asthma. There is no ideal treatment for acne until now. Conventional drugs are associated with recurrence of acne and disastrous side effects on long-term usage. Unani medicines are gaining increased popularity due to their advantages, such as better patient tolerance, long history of use, fewer side effects, and relatively less expensive. Furthermore, they have provided good evidence for the treatment of a wide variety of difficult-to-cure diseases. More importantly, other than consumption as preventive or treatment remedy, they might be accompanied by synthetic drugs to reduce their side effects. Topical Unani drugs are an important part of the treatment strategy in dealing with acne. Many Unani topical drugs with anti-inflammation, wound healing, and antibacterial activities are used in different ways in the treatment of acne and other infective diseases. The present paper presents a list of topical Unani drugs used in the prevention and treatment of acne vulgaris for centuries.
  - 4,266 294
Psychiatric treatment in the preneuroleptic era
Smitha Lamiya Rasquinha, Avinash Joe, AT Safeekh
July-December 2019, 7(2):298-302
Throughout history there were many attempts to understand the mind and to derive treatment options based on the presumed causes. This often resulted in many of the controversial and outlandish practices. In this article we have tried to emphasize on some of such practices, some more unusual than other, that have been used in the pre – neuroleptic era. Advancement in the field of science has changed the way we look at psychiatric disorders and brought transformation in the way we treat psychiatric patients.
  - 2,052 153
“When,” “What,” and “How” of complementary feeding: A mixed methods cross-sectional study from a rural medical college in central India
Priyanka A Joshi, Shiv H Joshi, Abhishek V Raut
July-December 2019, 7(2):217-223
Background and Aim: Undernutrition among under-five children is one of the most important public health problems in India. Despite several years of efforts to tackle undernutrition, India has not been able to make any significant dent on proportion of undernutrition. The aim of this study is to assess the quality of complementary feeding (CF) practices among mothers visiting immunization clinic of a rural medical college in central India. Materials and Methods: This hospital-based study was conducted among 190 consecutively recruited children between 6 and 23 months of age who visited the immunization clinic. Study design involves cross-sectional study using mixed methods. Sociodemographic details were recorded and anthropometric measurements were done using calibrated infantometer and electronic weighing scale. The adapted CF index (CFI) was administered that included questions on continuation of breast-feeding, initiation of CF, dietary diversity, food frequency, and responsive feeding. Freelisting was conducted with 20 different mothers. Calorific value of CF given was determined based on 24-h dietary recall. Results: The magnitude of underweight, stunting, and wasting was 25.8%, 27.9%, and 10%, respectively. Almost all (91.6%) of the children had received timely initiation of CF, but only 67.4% children had received dietary diversity and 75.5% of nonbreast fed and 77.7% of breast fed children received appropriate meal frequency. The CFI and calorific value of food had significant positive correlation. CFI score was significantly associated with stunting (Prevalence odds ratio (POR) 8.37, 95% Confidence interval: 1.09–64.2). The findings of CFI triangulate with findings of freelisting. The study participants showed poor intake of flesh foods (meat and eggs) and Vitamin-A rich fruits and vegetables. Starchy staples and other fruits were consumed more readily. Conclusion: CFI helps to readily assess the quality of CF. Complementary feeds given were not adequate in terms of minimum dietary diversity, meal frequency, and provision of required calories and protein.
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Lactate dehydrogenase and maternal and perinatal outcome in preeclamptic women
Simmi Kharb, N Bhandari, A Singh, A Gupta
July-December 2019, 7(2):163-166
Background: Preeclampsia is a condition that is characterized by hypertension and proteinuria occurring after 28 weeks of gestation. It complicates 5%–8% of all pregnancies. Lactate dehydrogenase (LDH) is an intracellular enzyme and its level is increased in preeclamptic women due to cellular death. Preeclampsia is a multisystem disorder and leads to a lot of cellular death. It carries substantial risks for both fetus and mother with a subsequent increase in the perinatal and maternal morbidity and mortality. Aim: The present study was planned to estimate and compare the serum LDH levels in women with preeclampsia and normal pregnant women and to correlate LDH levels with maternal and perinatal outcome in preeclampsia. Materials and Methods: This observational prospective study was conducted on 200 antenatal women. Women were divided into two groups, namely Group I (n = 100) comprised of women with preeclampsia (study group) and it was further subdivided into three categories on the basis of LDH levels: A (n = 53): <600 IU, B (n = 27): 600–800 IU, and C (n = 20): >800 IU and Group II (n = 100, control) comprised of normotensive pregnant women. LDH levels of both the groups were compared, and association of maternal and perinatal outcome was assessed in relation to LDH levels. Results: With increased severity of preeclampsia, rise in the LDH levels was observed. Severely preeclamptic women with LDH levels >800 IU/l showed a significant increase in incidence of eclampsia, abruption, hemolysis, elevated liver enzymes, and low platelet count syndrome, disseminated intravascular coagulation, and intensive care unit (ICU)/respiratory ICU transfer as compared to women who had lower levels <600 IU/l. A significant difference was observed among sepsis, mortality, and neonatal deaths between subgroups of preeclampsia according to the levels of LDH. Conclusion: LDH levels are associated with severity of preeclampsia and occurrence of maternal and fetal complications.
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Enterococcicidal activity of chlorine dioxide and lemon extract endorse them as contemporary root canal irrigants
Ramamurthi Arularasi Aberna, G Mohan, S Saranya
July-December 2019, 7(2):167-171
Background and Objective: Enterococcus faecalis offers challenges when present in an anatomically challenging and inaccessible site such as root canal and are instrumental in treatment failures. This emphasizes the need for irrigants besides mechanical instrumentation in root canal treatment to reinstate tooth structure and function. We explored the efficacy of chlorine dioxide and lemon extracts as alternatives to the conventional irrigant sodium hypochlorite on E. faecalis. Materials and Methods: The anti-enterococcal activity of the test and control irrigants was detected by disk diffusion method. The time taken by the chlorine dioxide, lemon extract (undiluted and 1:1 dilution), sodium hypochlorite, and saline to produce enterococcicidal activity was estimated by contact time studies, and the colony counts of E. faecalis at the time intervals of 1, 5, 10, 30, and 60 min and 24 h following exposure with irrigants were determined. Results: Chlorine dioxide and undiluted lemon extract demonstrated better anti-enterococcal activity than conventional irrigant sodium hypochlorite. Complete enterococcicidal activity was noted after a time interval of 1 min of exposure with chlorine dioxide, undiluted lemon extract, and sodium hypochlorite and after 10 min of exposure with 1:1 diluted lemon extract. Conclusion: The nonentity in literature on studies assessing the contact time of chlorine dioxide solution and lemon extract for their possibility as root canal irrigant gave an impetus for the study. Chlorine dioxide and undiluted lemon extract exhibited bactericidal activity against E. faecalis within 1 min of exposure equivalent to the activity of customary irrigant sodium hypochlorite, thus validating their possibility to be used as root canal irrigants.
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Misfolding linked mutations of SERPINA1 gene are uncommon in preeclampsia
Chandrakala Nagarajappa, Sheela Shikaripur Rangappa, Sharath Balakrishna
July-December 2019, 7(2):177-180
Background: Alpha-1 antitrypsin (A1AT) is a protease inhibitor that plays an important role in regulating oxidative stress in preeclampsia (PE). Recent studies have shown that A1AT is misfolded in PE. However, the cause of A1AT misfolding is not known. Mutations in SERPINA1 gene is an established source of A1AT deficiency. PiS and PiZ are the two common misfolding-associated mutations in the SERPINA1 gene. Objective: The purpose of this study was to evaluate the frequency of PiS and PiZ mutations in the SERPINA1 gene in preeclamptic women. Materials and Methods: We carried out a cross-sectional study by including 200 preeclamptic pregnant women. PiS and PiZ mutations in the SERPINA1 gene were genotyped by using polymerase chain reaction-restriction fragment length polymorphism method. Results: PiS and PiZ mutations were absent both in homozygous and heterozygous conditions in the preeclamptic womenConclusion: PiS and PiZ mutations in the SERPINA1 gene may not be associated with A1AT misfolding in PE.
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Mélange of orbital lesions – A histomorphologic study of 135 cases
Rashi Gupta, Suguna Belur Venugopal, Aparna Muralidhar, V Geethamani, Ankit Malhotra
July-December 2019, 7(2):181-185
Background: The orbit is an important site for primary and secondary diseases. Various tissue types such as osseous, vascular, neural, muscular, and glandular may be involved with specific pathologies. Tumors can secondarily invade the orbit from the periorbital regions including the paranasal sinuses, eyelids, and intracranial region. Objectives: (i) To assess the histomorphology of various orbital lesions. (ii) To determine the frequency, age, and sex distribution of various orbital lesions in our study population and compare them with the other studies. Materials and Methods: The study involved 135 patients of either sex presenting with orbital lesions reporting to a tertiary care hospital. Results: Among the 135 cases, we observed a slight female predominance, with a female-to-male ratio being 1.17:1. Most of the patients were in their fifth decade and presented with exophthalmos. Histopathologically, cystic lesions were most frequent followed by lymphoproliferative lesions. About 25% of lesions were malignant and included lymphomas, lacrimal gland malignancies, and rhabdomyosarcomas predominantly. We came across a rare case of intravenous papillary endothelial hyperplasia. Conclusion: Orbital lesions arise primarily from soft tissues and bones. The frequency of orbital lesions varies among different series depending on age group, source institution, medical specialty, and geographic areas. Histopathology remains the mainstay of diagnosis. In addition to determining the malignant potential of a lesion, it reveals its exact nature and structure, thereby influencing management and prognosis.
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Alcohol dependence syndrome in suicide attempters: A cross-sectional study in a rural tertiary hospital
P Sreelatha, G Haritha, V S. S R. Ryali, Ryali P Janakiraman
July-December 2019, 7(2):195-200
Background: Suicidal attempt is a phenomenon with a tremendous impact on the medical and social well-being of the individual, and alcohol abuse/dependence has consistently been implicated in the triggering of suicidal attempt. This complex interaction of alcohol and suicide needs further exploration. Aim: This study aimed to examine the frequency of alcohol dependence in suicidal survivors and assess the association of sociodemographic and clinical variables with the severity of dependence in suicide attempters. Materials and Methods: It is a hospital-based, cross-sectional, observational study set in a tertiary care institute where a total of 175 admitted cases of suicidal attempt were included. Patients referred to the department of psychiatry of a teaching hospital in Andhra Pradesh within the study period were enrolled after informed consent. With usual detailed workup, alcohol dependence was ascertained. Relevant information was recorded in a pro forma. Alcohol use/dependence was grouped into various categories in relation to suicidal attempt. Results: Alcohol was consumed by 43.43% of suicide attempters. Alcohol dependence constituted of 30.29%. Severe dependence was present in 9.14% of participants. There was a positive correlation between suicidal intent, lethality of attempt, history of smoking, and psychiatric comorbidity with the groups segregated based on the severity of dependence. Conclusion: High suicidal intent and lethality of attempt are risk factors of attempt in moderate-to-severe dependence. Effective treatment of alcohol dependence can mitigate suicidal attempts.
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Childhood blistering distal dactylitis: An uncommon cutaneous manifestation of Staphylococcus aureus
Maqbool Saep, Malcolm Pinto, Sateesh K Malkappa
July-December 2019, 7(2):309-310
Blistering distal dactylitis (BDD) is a rare, bacterial skin infection presenting as bullous lesions over the fingers, especially in the age group of <16 years. We present a case of a child presenting with BDD secondary to Staphylococcus aureus infection.
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Nasal dermoid
Satvinder Singh Bakshi
July-December 2019, 7(2):311-312
Nasal dermoid is a rare developmental anomaly arising from a cluster of epithelium trapped during the embryological development or failure of obliteration of the ectodermal extension. Progressive enlargement can lead to soft tissue or skeletal deformity or intracranial complications such as meningitis or abscess. Timely diagnosis and complete surgical excision are essential to avoid complications. We describe a 23 year old male presenting with nasal dermoid.
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Intracranial hypertension secondary to levofloxacin-therapy
Jamir Pitton Rissardo, Ana LetŪcia Fornari Caprara
July-December 2019, 7(2):313-316
Idiopathic intracranial hypertension (ICH) is characterized by elevated intracranial pressure without an evident etiology. Here, we report the case of an adult male who presented with headache, diplopia, blurred vision, and nausea. The patient stated that he had searched a general practitioner 1 week ago because he had experienced cough, dyspnea, and fever. The physician started levofloxacin. On admission, the patient reported that his respiratory symptoms recovered. However, he complained about the beginning of neurological symptoms. On neurological examination, papilledema and unilateral abducens weakness were observed. A brain magnetic resonance imaging showed radiographic features of ICH. A lumbar puncture had an opening pressure of 50 cmH2O. Levofloxacin was withdrawn, and acetazolamide 250 mg bid was started. After 2 weeks, the patient had full recovery of the symptoms, and 4 weeks later, no papilledema was observed.
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Recurrent aphthous stomatitis
Satvinder Singh Bakshi, Sumita Bakshi
July-December 2019, 7(2):317-318
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