Journal of Pain

EDITORIAL
Percutaneous vertebroplasty: Current controversy p. 123
Kailash Kothari
DOI:10.4103/ijpn.ijpn_67_18
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REVIEW ARTICLES Top
zoom.png Full-endoscopic lumbar discectomy for high canal compromised disc at upper lumbar level: A technical review p. 125
Manish Raj, Kailash Kothari, Anurag Agarwal, Hyeun Sung Kim, Pankaj Surange, Kapil Tyagi, Prashant Punia, Palea Ovideu
DOI:10.4103/ijpn.ijpn_51_18 Objective: In this study, we have described the technique to overcome difficulty faced during trans-foraminal endoscopic discectomy for the treatment of lumbar radiculopathy in patients who have herniated discs at the upper lumbar level & thoracolumbar junction. Method: After institutional review board approval, A retrospective analysis of 27 patients operated between March 2013- September 2017, by a single specialist for disc herniation at upper lumbar levels D12-L1, L1-2, L2-3 with or without high canal compromise by outside in technique (using rigid endoscope, sequential reamers) along with detailed description of our technique is the focus of this study. Results: Out of 27 patients there were 11 cases for L1-2 & 16 cases of L2-3 disc herniation respectively. There were 21 cases of broad-based, high canal compromised disc herniation with significant neurological deficit & only 6 cases were of focal herniation type. The average preoperative VAS score of 8.5 (range 6-10) reduced to 4 (range 2-7) immediate postoperatively & it further reduced to 2 (range 0-4) at one month follow up. The average preoperative ODI score of 65 (range 28- 88) reduced to 27 (range 12-40) immediate postoperatively & it further reduced to 10 (range 3- 18) at one month follow up. Post-operative MRI showed that the ruptured disc had been successfully removed. Conclusion: An anatomically modified surgical technique promote a more successful outcome after percutaneous endoscopic discectomy for upper lumbar disc herniation. Foraminotomy is recommended for all intra-canalicular herniation. Transforaminal endoscopic discectomy and foraminotomy can be used as a safe yet minimally invasive technique for the treatment of lumbar radiculopathy in the setting of an upper lumbar disc herniation.
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zoom.png Pharmacological management of neuropathic pain in India: A consensus statement from Indian experts p. 132
Ashok Kumar Saxena, Parmanand Jain, Gur Prasad Dureja, Anil Venkitachalam, Subrata Goswami, Hammad Usmani, Shardul Kothari, Dipit Sahu, Baljit Singh, Vandana Trivedi, Gaurav Sharma, Sanjay Kamble, Amit Qamra, Salman Motlekar, Rishi Jain
DOI:10.4103/ijpn.ijpn_47_18 Neuropathic pain (NeP) constitutes a major pain-related disorder, which is often underdiagnosed and undertreated. Adverse physical, psychological, and economic consequences associated with NeP lead to poor quality of life. Burden of NeP in developing countries like India is colossal. Various international guidelines provide effective approaches to diagnose and manage NeP. However, differences in the genetic makeup of Indian population can result in subtle differences in clinical response, considering their low body weight, drug metabolism ability, and pain perception. Similarly, treatment-related adverse effects may also vary. Practice of Indian physicians may also differ for choice of drugs based on their availability and affordability. In the absence of country-specific guidelines, this document could serve as a guiding tool for health-care providers, ensuring uniformity in the treatment of NeP. Thus, applicability of all recommendations from any of these guidelines in Indian setting demands careful evaluation. Clinical experience of Indian physicians suggests that there are lot many challenges (e.g., busy outpatient departments, nonavailability of screening questionnaires in regional languages, and availability and affordability of medications) faced by them when managing NeP. In addition, in India, there are no country-specific guidelines that would help them to address these challenges. The objective for this consensus was to develop an expert opinion guideline to harmonize the management of NeP in India. The expert panel consisted of experts from various specialties such as pain medicine, anesthesiology, diabetology, neurology, and orthopedics. The panel critically reviewed the existing literature evidence and guideline recommendations to provide India-specific consensus on the management of NeP. The final consensus document was reviewed and approved by all the experts. This expert opinion consensus will help health-care professionals as a guiding tool for effective management of NeP in India. Use of Douleur Neuropathique 4 (DN4) questionnaire for NeP screening should be routine in day-to-day clinical practice. For effective utilization of DN4 questionnaire, it should be converted to regional language. If DN4 questionnaire screening fails to identify NeP, it should not be disregarded and should not replace the sound clinical judgment from the treating physician. Diagnostic tests may be considered as a supplement to clinical judgment. Cost-effective treatment should be the initial choice. Dosing should be individualized based on efficacy and tolerability. Tricyclic antidepressants (TCAs), gabapentinoids, and serotonin-norepinephrine reuptake inhibitors (SNRIs) can be considered among initial choices. Tramadol can be considered as a second-line add-on treatment for NeP if there is partial response to the first-line agent either alone or in combination. Fixed-dose combination (FDC) of gabapentinoids such as pregabalin (75 mg) with TCA such as nortriptyline (10 mg) is synergistic and improves treatment adherence. Among other treatments, Vitamin B12 (methylcobalamin) can be used either alone or in combination for the management of NeP. Use of Vitamin D and steroids should be limited to specific NeP in individual cases. Referral to pain specialists can be considered if two drugs fail to provide relief in NeP.
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ORIGINAL ARTICLES Top
zoom.png Is tactile acuity altered in individuals with acute mechanical neck pain? p. 145
Shobhalakshmi S Holla, Turiya Vats, Pratima Nagpal
DOI:10.4103/ijpn.ijpn_20_18 Background: Tactile acuity measured by point discrimination (TPD) refers to the precision by which we can sense touch.An increase in TPD threshold (loss of tactile acuity) is considered suggestive of disruptions to S1 cortical maps of that specific body part. In some chronically painful conditions, reduced tactile acuity is a manifestation of Central sensitization (CS).The other symptoms include hyperalgesia and allodynia due to repeated activation of spinal nociceptors. A recent study has shown that tactile acuity is affected in individuals with chronic neck pain. While there seems to be adequate evidence stating that tactile acuity is reduced in individuals with chronic pain, CS may not be limited to chronic pain states. There is a paucity of literature with respect to the tactile acuity of a person with acute neck pain. A measurement of tactile acuity of the affected body area in acute pain, may suggest the extent of the altered threshold of sensory discriminative aspect of pain experience. Objectives: To compare the two-point discrimination over C7 spinous process between the symptomatic individuals with mechanical neck pain and age matched healthy controls. Methods: 30 individuals with mechanical neck pain & 30 age matched normals were assessed for two point discrimination using mechanical calipers, The two sharp points of the caliper were vertically placed against the skin surface over C7 spinous process, commencing with 5mm, which was stretched out till the subject appreciated the two points. Values were noted down in millimeters. Results: An independent t – test showed a significant difference in the two point discrimination between the 2 groups (P < 0.000). Conclusion: It can be concluded that individuals with acute mechanical neck pain demonstrated a change in tactile acuity.
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zoom.png A comparative study of ultrasound-guided femoral nerve block versus fascia iliaca compartment block in patients with fracture femur for reducing pain associated with positioning for subarachnoid block p. 150
Neena Jain, Pooja Rawat Mathur, Veena Patodi, Saurav Singh
DOI:10.4103/ijpn.ijpn_21_18 Context: Lower extremity peripheral nerve blocks are increasingly being recommended for pain control in patients with fracture femur as it reduces pain and shortens the duration of hospital stay. Aims: To compare analgesic efficacy of ultrasound guided femoral nerve block (FNB) and fascia iliaca compartment block (FICB) in patients with fracture femur for reducing pain associated with positioning for subarachnoid block. Settings and Design: It was a prospective, randomized, double blind study. Methods and Material: Group A (n = 25) received ultrasound guided FNB and Group B (n = 25) received ultrasound guided FICB using 0.5% ropivacaine. Primary objective was to observe reduction in pain associated with positioning (sitting) for subarachnoid block. Statistical Analysis used: For data analysis t test, Mann Whitney test and Chi-square test were applied. Results: Visual analog scale (VAS) score for pain before giving peripheral nerve block between Group A (7.60 ± 0.57) and Group B (7.44 ± 0.50) was comparable (P = 0.302). VAS score for pain in sitting position before giving subarachnoid block was lesser in Group A (1.88 ± 0.83) than in Group B (2.40 ± 0.57) (P = 0.013). Mean reduction in VAS score for pain was more in Group A (5.72 ± 0.73) compared to Group B (5.04 ± 0.73) (P = 0.002). Conclusion: Ultrasound guided FNB is more efficacious in reducing pain associated with positioning (sitting) for subarachnoid block in patients undergoing surgery for fracture femur compared to ultrasound guided FICB.
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zoom.png Image guided trans foraminal epidural injection: Is it a viable stopgap therapy for low backache p. 155
Samaresh Sahu, Rochan Pant, Sashank Sharma
DOI:10.4103/ijpn.ijpn_33_18 Aims: 1. Study the change in pain and function in patient with lumbosacral disc disease on MRI using visual analogue scale (VAS) and the revised Oswestry disability index (ODI) for back pain after administration of fluoroscopically guided transforaminal epidural injection. 2. Correlate the response of the patient with the spread of contrast in epidural space. Method: 100 patients with history of low back ache and imaging findings of disc herniation were enrolled based on inclusion criteria. Patients scored their pain on the VAS and functional disability on revised ODI. The patient was evaluated for distribution of pain and was administered a combination of anaesthetic and steroid after confirming the position of the tip of needle using iodinated contrast. Follow up for response to pain and improvement in disability in immediate post procedure done at 3 and 6 months. Result: 102 injections were administered for 100 patients which comprised of n=69 {67.6%} male and 33{32.4%} female and age distribution was 21-79 years. The distribution of indication was disc bulge n=29 (28.4%), extrusion n=12 (11.8%), post operative n=19 (18.6%), protrusion n=42 (41.2%). No significant difference between the VAS scores (p=0.20) of the individual indication pre procedure. After 3 & 6 months there was statistically significant difference between the mean rank value of population indicating maximum benefit for disc bulge population and least for post operative population at three months follow up. Conclusion: There is statistically proven good results in all cases for 6 months, after which repeat injections may be tried.
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zoom.png Perception, knowledge, and attitudes of first-year postgraduates toward postoperative pain management: A questionnaire-based study p. 163
Pritam B Adsule, Pradnya M Bhalerao, Prakash R Dhumal
DOI:10.4103/ijpn.ijpn_31_18 Context: Inadequately controlled postoperative pain has undesirable physiological and psychological consequences. It increases postoperative morbidity, delays recovery, and hence causes a delayed return to normal daily living. Furthermore, the lack of adequate postoperative pain treatment may lead to persistent pain after surgery, which is often overlooked. Overall, inadequate pain management increases the use of health care resources and health care costs. Aim: To evaluate the knowledge and attitudes of first-year postgraduate students toward postoperative pain. Study Design: This questionnaire-based cross-sectional study was conducted on 42 first-year postgraduate students. Materials and Methods: A 20-point questionnaire was prepared based on the various aspects of postoperative pain services. The students were asked to provide their answers on a five-point Likert scale ranging from “strongly disagree” to “strongly agree.” The responses were kept anonymous, and the results were expressed in terms of percentage. Results:Almost 70% of students had a good knowledge of opioids, 52% strongly felt the need for a structured pain curriculum, 76% were well aware of nonpharmacological methods of pain relief, 48% agreed on the need for a pain physician, and 52% were aware of the advantage of postoperative analgesia. Conclusion: This pilot study helped us to evaluate the current understanding of our first-year postgraduate students and further created awareness on the importance of pain relief postoperatively.
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Executive function and its clinical correlates among migraineurs p. 167
Ashitha Sreedhar, Suresh M Kumar, Anjali N Shobha
DOI:10.4103/ijpn.ijpn_38_18 Background: The studies conducted in the field of migraine and its effect on various cognitive functions revealed contradicting results mainly due to the incorporation of patients from varied socioeconomic status, clinical conditions, and the methodology adopted to the study. Methods: The participants of the study consist of 130 migraineurs, selected from the outpatient department of neurology from reputed tertiary centers at Chennai, South India, and controls were picked up from the community. Patients were selected on the basis of clinical examination and screening. The instruments used are Migraine Severity Scale, Headache impact test, hospital anxiety and depression scale (HADS), Wisconsin Card Sorting Test, Trail Making Test, and Controlled Oral word Association Test. Results: The study found that migraine group to have deficits in some aspects of problem-solving and concept formation competencies in comparison with healthy individuals and also found strong and weak correlation with various clinical variables such as its severity, duration, and headache impact indicating the role of migraine on cognitive functioning. Conclusion: The condition of migraine does lead to mild-to-moderate levels of impairment in various frontal lobe-involved cognitive functions such as attention, planning, and problem-solving even in a high-profile samples having higher levels of education and occupation. The relation between the migraine and impairment in cognitive functions are further cemented by the strong correlation found between various clinical factors such as its severity, duration, and its impact. Findings from such a study will also pave new ways and means to incorporate the implementation of a holistic approach in the treatment and management of migraine, and thereby to enhance the quality of life of these patients.
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zoom.png Translation and validation of Marathi version of Fear-Avoidance and Belief Questionnaire in patients with chronic low back pain p. 173
Vrushali P Panhale, Reshma S Gurav, Kartiki Suradkar
DOI:10.4103/ijpn.ijpn_41_18 Background: Fear-Avoidance Beliefs Questionnaire (FABQ) is widely used to assess the fear-avoidance beliefs in patients with low back pain (LBP). However, English serves as a barrier to the population of the state where Marathi is the prime language. Hence, the FABQ needs to be translated into Marathi for the ease of its use. Materials and Methods: FABQ was successfully translated in Marathi using forward-backward translation using recommended guidelines. The final version of FABQ-Marathi version (FABQ-M) was used on 100 patients with chronic nonspecific LBP to assess its reliability and validity. Reliability was assessed by measuring the internal consistency of FABQ-M and its subscales and by checking the test-retest reliability on day 1 and day 2. For the determination of construct validity, convergent and divergent validity was assessed. The floor and ceiling effects were studied. Results: Reliability-internal consistency-Cronbach’s alpha for FABQ-M was 0.860 and test–retest: correlation between FABQ-M on day 1 and day 2 were highly significant. The intraclass coefficient was 0.976. There was a high internal consistency between the FABQ-M and its subscales. On assessing convergent validity, there was moderate correlation found between FABQ-M and TSK (r = 0.52, P = 0.00). Divergent validity showed moderate correlation between FABQ-M and NRS (r = 0.48, P = 0.00) and between FABQ-M and RMDQ (r = 0.59, P = 0.00). Conclusion: The translated FABQ-M proved to be acceptable. The results suggest it is a validated, an easy to comprehend, reliable, and valid instrument for the measurement of the fear and avoidance beliefs caused by back disorders in the Marathi-speaking population.
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CASE SERIES Top
zoom.png A case series discussing the intrathecal drug delivery system to improve the quality of life in terminal cancer patients p. 179
Joanna Samantha Rodrigues, Preeti Gupta, Shalini Saksena, Manju Butani
DOI:10.4103/ijpn.ijpn_49_18 Cancer is a life changing diagnosis and chronic pain in these terminally ill patients is extremely debilitating. In the present case series, the feasibility of continuous infusion of low dose local anaesthetics and opioids through the intrathecal route has been discussed pertaining to patient selection, technique, drugs used and trouble shooting. The intrathecal catheters were connected through a subcutaneous port to an external ambulatory infusion device (CADD pump) and used on a home care basis.
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CASE REPORTS Top
Quadratus lumborum: One of the many significant causes of low back pain p. 184
Asha Satish Barge, Satish Mahadeo Barge
DOI:10.4103/ijpn.ijpn_53_18 Quadratus lumborum is one of the common sources of pain and that can be missed or ignored easily. Quadratus lumborum pain syndrome is a myofascial pain syndrome. The pain is due to spasm and stiffness of the muscle. Many a times, weak back muscles are compensated by quadratus lumborum leading to painful spasm. It is diffi cult to differentiate between quadratus lumborum and iliopsoas pain syndrome. Diagnostic quadratus lumborum injection helps differentiate between these two. In this report, we reported a case of quadratus lumborum pain syndrome as a primary diagnosis and iliopsoas pain syndrome as a secondary diagnosis. The diagnosis was confi rmed by fl uoroscopically guided quadratus lumborum injection.
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zoom.png Management of chronic postsurgical pain following cholecystectomy p. 187
Parthasarathy Srinivasan, Gobinath Jayaraman
DOI:10.4103/ijpn.ijpn_36_18 A 50-year-old female presented with severe pain at the cholecystectomy scar site of 4 months’ duration. She had an open cholecystectomy done followed by continuous pain from the time of discharge. She was diagnosed as a case of chronic postsurgical pain (CPSP) syndrome. We administered right-sided erector spinae (ES) block by ultrasound guidance depositing 15 ml of 0.25% bupivacaine and 40 mg of methylprednisolone at site of incision. The visual analog score showed significant improvement from 7/10 to 2/10 for the next 2 months of follow-up. We conclude that ultrasonography-guided ES block combined with intralesional steroid is a viable treatment option in cases of CPSP. This is possibly the first case report of postcholecystectomy chronic pain managed with ES block.
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Horner syndrome: A hidden benign complication of cervical epidural injection p. 190
Sudheer Dara, Minal Chandra, Rachna Varma
DOI:10.4103/ijpn.ijpn_59_18 Cervical epidural steroid injection is an intervention done for cervical prolapsed intervertebral disc. Cervical epidural steroid injection is done if a patient has not responded to medications and physical therapy. We discuss a case report of the occurrence of Horner’s syndrome in the patient with cervical radiculopathy undergoing cervical interlaminar epidural steroid injection which resolved spontaneously without residual side effects.
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Journal of Pain

Molecular pathways of oral cancer that predict prognosis and survival

Several genes and pathways associated with oral squamous cell carcinoma (OSCC) are significant in terms of early detection and prognosis. The objective of this literature review is to evaluate the current research on molecular pathways and genes involved in oral cancer. Articles on the genes involved in oral cancer pathways were evaluated to identify potential biomarkers that can predict survival. In total, 36 articles were retrieved from internet databases, including EBSCO Host, Google Scholar, PubMed, and Science Direct, using the keywords “biomarker of oral cancer,” “pathways of oral cancer,” “genes involved in oral cancer,” and “oral cancer pathways.” A total of 36 studies related to OSCC were chosen. Most of the studies used cell lines, while others used archival tissues, few studies followed up the cases. Three major interlinked pathways found were the nuclear factor kappa B (NF-kB), PI3K-AKT, and Wnt pathways. The commonly mutated genes were cyclin D1 (CCND1), Rb, p53, FLJ10540, and TC21. The NF-kB, PI3K-AKT, and Wnt pathways are most frequently involved in the molecular pathogenesis of oral cancer. However, the CCND1, Rb, p53, FLJ10540, and TC21 genes were found to be more accurate in determining patients’ overall survival. Polymerase chain reaction, immunohistochemistry, and immunoblotting were the commonly used detection methods.

Keywords: Biomarkers, molecular pathways, prognosis, survival, targeted therapy

http://www.carcinogenesis.com/article.asp?issn=1477-3163;year=2018;volume=17;issue=1;spage=7;epage=7;aulast=Lakshminarayana

Molecular pathways of oral cancer that predict prognosis and survival

MAMC Journal of Medical Sciences, a publication of Maulana Azad Medical College

Draft Charter of Patients’ Rights: An Appraisal
Vivek R Minocha

MAMC Journal of Medical Sciences 2018 4(3):113-115

Retinopathy of Prematurity
Mukta Sharma, Arti Sareen, Sunder Singh Negi

MAMC Journal of Medical Sciences 2018 4(3):116-120

Retinopathy of Prematurity (ROP) is a bilateral proliferative retinopathy affecting premature infants with low birth weight,who have been exposed to excessive oxygenation, resulting in dysregulated vascular endothelial growth factor expression and thus untimely vasoobliteration or exaggerated vasoproliferation.Screening for ROP is mandatory in such infants so as to prevent this blinding disorder.

The Safety and Efficacy of Frame-Based Stereotactic Biopsy of Brain Lesion
Wisam H Mohammed, Ahmed R Obaid, Ali K Al-Shalaji, Samer S Hoz, Bishree K Shakir, Luis R Moscote-Salazar

MAMC Journal of Medical Sciences 2018 4(3):121-127

Background Radiological imaging techniques provide early detection of neurological diseases, but they do not always provide an adequate diagnosis. With the help of stereotactic biopsy techniques, it is possible to access deep-brain lesions safely and with high precision, being crucial in the elaboration of therapeutic strategies and prevents unnecessary neurosurgical interventions. Aim To evaluate the safety, diagnostic yields, and associated mortality and morbidity of computed tomography-guided stereotactic biopsy for intracranial lesions. Materials and Methods A retrospective study of all pathologically diagnosed intracranial biopsies, between 2010 and 2016 in Baghdad Neurosurgical Teaching Hospital, was conducted. Stereotactic biopsies were performed by using the Leksell stereotactic frame in 116 patients. Medical charts, radiological studies, and postoperative complications were reviewed, and then the information was analyzed. Results A total of 116 patients underwent stereotactic surgery procedures. Patients consisted of 66 females and 50 males, ages ranging from 7 to 74 years (mean 44.4 ± 19.35 years). General anesthesia was used in 88 patients. The rest were performed under local anesthesia. The overall diagnostic yield was 98.3%. Complications were observed in 8.6% of the cases, with morbidity 5.1% of the cases, and the overall mortality rate was 3.4%. These results are comparable to other reports. Other clinical, radiological, or histological variables were not associated with an increased risk of complications. Conclusion Our findings support that frame-based stereotactic biopsy is a relatively safe and valuable technique that allows the neurosurgeon to obtain tissue samples for histopathological diagnosis of most of the intracranial mass lesions.

Text-Messaging to Supplement Classroom Teaching: A Nonrandomized Controlled Trial
Anurag Agarwal, Sumaira Khalil, Mohit Sethi, Devendra Mishra

MAMC Journal of Medical Sciences 2018 4(3):128-132

Introduction Short messaging service (SMS), or text messaging is highly accepted in medical education of health workers and patients. This study was conducted to evaluate if SMS-based supplementation of key messages with conventional classroom teaching compared to conventional teaching results in a better cognitive performance of undergraduate medical students. Materials and Methods Setting: Department of pediatrics of a public medical college in India. Participants: Ninety-two final-year undergraduate medical students. Study design: Single-center, nonrandomized, controlled trial. Intervention: One batch was given SMS-based key messages in addition to conventional teaching (intervention group, n = 48), as compared to only conventional teaching of the other (control, n = 44) batch. The text messages pertained to five predetermined topics of the teaching session and were sent in the evening of the day the topic was taught. Primary outcome variable: Scores in a multiple-choice question (MCQ)-based test at the end of posting of each batch. Results A total of 92 final-year MBBS students were enrolled in the study. There was no statistically significant difference between the performance of the study participants in the post-intervention MCQ test in the two groups [mean (standard deviation) scores, 13.4 (1.55) vs. 9.7 (3.49), P > 0.05], even after subgroup analysis for high scorers and low scorers. The total cost of sending the messages was less than Rs. 100. Conclusion There was no statistically significant effect on cognitive performance following a supplementation of classroom teaching by SMS-based key messages. However, given the low cost of this methodology and the reported high acceptance of this method by students, there is a need for more well-planned studies to confirm these results.

Status of Noncommunicable Disease Screening in an Urban Resettlement Colony in Delhi, India: A Descriptive Cross-Sectional Study
Ruchira Pangtey, Saurav Basu, Gajendra S Meena, Bratati Banerjee

MAMC Journal of Medical Sciences 2018 4(3):133-136

Background Noncommunicable diseases (NCDs) are responsible for more than two-third cases of premature mortality (30–69 years) in India. Screening for NCDs is the most effective means for detection of undiagnosed NCD cases and early treatment initiation that lowers morbidity and mortality due to these diseases. The objective of the present study was to assess the NCD screening status in an urban resettlement colony of Delhi. Materials and Methods A community-based cross-sectional study was conducted among residents of the area. Patients with preexisting hypertension and diabetes and aged below 30 years were excluded. The patients were further screened for hypertension by taking three separate readings using an aneroid sphygmomanometer. The Indian Diabetes Risk Score (IDRS) was calculated to evaluate diabetes risk. Results A total of 110 men and 103 women (N = 213) met the inclusion criteria. The mean (±standard deviation) age of the patients was 40 (±9.3) years. A history of previous screening for hypertension and diabetes was reported by 73 (34.2%) and 40 (35.4%) patients, respectively. A medium or high-risk of having diabetes mellitus as per the IDRS score was present in most (88.4%) patients. On current screening, nine (8.2%) men and nine (8.7%) women were identified as undiagnosed hypertension cases. Only four (3.8%) women had undergone a clinical breast exam, and just nine (8.7%) women ever had a Pap smear examination. Conclusion The present study shows that the current strategy of opportunistic screening for NCDs has been unable to reach large segments of vulnerable and at risk populations.

Coarctation of Aorta With Valvular Heart Disease: A Hybrid Approach
Ankit Jain, Prerit Agarwal, Subodh Satyarthy, Kuber Sharma, Muhammed A Geelani

MAMC Journal of Medical Sciences 2018 4(3):137-141

We describe the management of three patients with coarctation of aorta (COA) associated with valvular heart disease. All the three patients underwent initial balloon dilatation following which they underwent surgical correction of the valvular pathology. Staged approach in such diseases has better outcome in terms of morbidity and mortality. Both single-stage and two stage operations can be used. As surgical correction of COA is frequently associated with potential complications, we adopted the staged approach for better results. Background COA with valvular heart disease is generally a rare combination. Both these entities require correction which can be done simultaneously or as staged procedure. Objective To study the outcome of staged procedures in such patients. Materials and Methods We managed 3 patients with COA associated with valvular heart disease. Results All the 3 patients had uneventful post operative recovery. At the time of discharge gradients were <20 mm Hg across the coarctated segment. Post operative echocardiography (echo) after 3 months on follow up were normal. Conclusion Simultaneous surgical correction of COA along with valvular heart disease is associated with potential surgical and anesthetic complications. Hence staged procedures are preferred if the anatomy of coarctation is feasible for endovascular correction.

Anesthetic Considerations in a Child With IgG4 Disease
Summit D Bloria, Ketan Kataria, Ankur Luthra, Pallavi Bloria

MAMC Journal of Medical Sciences 2018 4(3):142-144

Immunoglobulin G4 (IgG4)-related disease is a relatively newly coined term for a disease which affects various body organs. There is tissue invasion of IgG4-positive plasma cells into tissues leading to various manifestations like lymph node enlargement, autoimmune pancreatitis, pulmonary manifestations, hepatic disease, and others. We describe the anesthetic management of a pediatric patient suffering from IgG4-related disease with systemic manifestations who underwent a ventriculoperitoneal shunt revision.

Emergency Cesarean Delivery in a Parturient With Intracranial Tumor: Anesthesiologist’s Challenge
Kapil Chaudhary, Sandeep Mehra, Kirti N Saxena, Bharti Wadhwa, Himanshu Sikri

MAMC Journal of Medical Sciences 2018 4(3):145-148

Anesthetic management of a patient having an intracranial tumor undergoing cesarean section is challenging because of a combination of factors including their diagnosis, physiological changes of pregnancy, fetal viability concerns and complexity of surgical and anesthetic interventions. The scenario is more challenging in emergency surgery as the time for optimization and multidisciplinary involvement is minimal. We discuss successful management of a term primigravida with intracranial tumor who presented for emergency cesarean delivery. The anesthetic challenges and the management options are discussed.

Ventriculoperitoneal Shunt-Associated Meningitis Caused by Candida auris: A Case Report
Rohit Chawla, Anuj Sud, Nadeem Ahmad, Chander Prakash Baveja

MAMC Journal of Medical Sciences 2018 4(3):149-151

Candida auris was first isolated in Japan in 2008. Since then, it has become an emerging global threat due to its role in outbreaks in healthcare facilities and its decreased susceptibility to multiple antifungal agents. We report a case of ventriculoperitoneal shunt-associated meningitis caused by C. auris in a patient who had a history of tubercular meningitis and hydrocephalus. The isolate was initially misidentified as Candida krusei based on purple-colored colonies on Modified HiCrome Candida Differential Agar but was finally identified as C. auris on VITEK-2 compact (version 8.01). The isolate had a high minimum inhibitory concentration (MIC) for fluconazole, whereas the MICs for other major classes of antifungals were low.

Intractable Chylothorax Following Mitral Valve Replacement in an Adult
Ankit Jain, Arindam Roy, Saumya S Jenasamant, Manish Jawarkar, Harpreet S Minhas

MAMC Journal of Medical Sciences 2018 4(3):152-154

Chylothorax after an open-heart surgery has previously been mentioned in the literature. We report this association in a young female post-mitral valve replacement surgery due to abnormal lymphatic channels. Medical management was conducted for 4 weeks. On failure of the conservative treatment, she underwent pleurectomy with suture ligation of the thymic gland remnants and pericardium for the chylothorax, which resolved following the redo surgery. This rare incidental variation in lymphatic drainage was responsible for refractory chylothorax, which otherwise could have been managed medically.

EDITORIAL
Draft Charter of Patients’ Rights: An Appraisal p. 113
Vivek R Minocha
DOI:10.4103/mamcjms.mamcjms_50_18
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REVIEW ARTICLE Top
zoom.png Retinopathy of Prematurity p. 116
Mukta Sharma, Arti Sareen, Sunder Singh Negi
DOI:10.4103/mamcjms.mamcjms_66_17 Retinopathy of Prematurity (ROP) is a bilateral proliferative retinopathy affecting premature infants with low birth weight,who have been exposed to excessive oxygenation, resulting in dysregulated vascular endothelial growth factor expression and thus untimely vasoobliteration or exaggerated vasoproliferation.Screening for ROP is mandatory in such infants so as to prevent this blinding disorder.
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ORIGINAL ARTICLES Top
The Safety and Efficacy of Frame-Based Stereotactic Biopsy of Brain Lesion p. 121
Wisam H Mohammed, Ahmed R Obaid, Ali K Al-Shalaji, Samer S Hoz, Bishree K Shakir, Luis R Moscote-Salazar
DOI:10.4103/mamcjms.mamcjms_3_18 Background Radiological imaging techniques provide early detection of neurological diseases, but they do not always provide an adequate diagnosis. With the help of stereotactic biopsy techniques, it is possible to access deep-brain lesions safely and with high precision, being crucial in the elaboration of therapeutic strategies and prevents unnecessary neurosurgical interventions. Aim To evaluate the safety, diagnostic yields, and associated mortality and morbidity of computed tomography-guided stereotactic biopsy for intracranial lesions. Materials and Methods A retrospective study of all pathologically diagnosed intracranial biopsies, between 2010 and 2016 in Baghdad Neurosurgical Teaching Hospital, was conducted. Stereotactic biopsies were performed by using the Leksell stereotactic frame in 116 patients. Medical charts, radiological studies, and postoperative complications were reviewed, and then the information was analyzed. Results A total of 116 patients underwent stereotactic surgery procedures. Patients consisted of 66 females and 50 males, ages ranging from 7 to 74 years (mean 44.4 ± 19.35 years). General anesthesia was used in 88 patients. The rest were performed under local anesthesia. The overall diagnostic yield was 98.3%. Complications were observed in 8.6% of the cases, with morbidity 5.1% of the cases, and the overall mortality rate was 3.4%. These results are comparable to other reports. Other clinical, radiological, or histological variables were not associated with an increased risk of complications. Conclusion Our findings support that frame-based stereotactic biopsy is a relatively safe and valuable technique that allows the neurosurgeon to obtain tissue samples for histopathological diagnosis of most of the intracranial mass lesions.
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zoom.png Text-Messaging to Supplement Classroom Teaching: A Nonrandomized Controlled Trial p. 128
Anurag Agarwal, Sumaira Khalil, Mohit Sethi, Devendra Mishra
DOI:10.4103/mamcjms.mamcjms_26_18 Introduction Short messaging service (SMS), or text messaging is highly accepted in medical education of health workers and patients. This study was conducted to evaluate if SMS-based supplementation of key messages with conventional classroom teaching compared to conventional teaching results in a better cognitive performance of undergraduate medical students. Materials and Methods Setting:Department of pediatrics of a public medical college in India. Participants: Ninety-two final-year undergraduate medical students. Study design: Single-center, nonrandomized, controlled trial. Intervention: One batch was given SMS-based key messages in addition to conventional teaching (intervention group, n = 48), as compared to only conventional teaching of the other (control, n = 44) batch. The text messages pertained to five predetermined topics of the teaching session and were sent in the evening of the day the topic was taught. Primary outcome variable: Scores in a multiple-choice question (MCQ)-based test at the end of posting of each batch. Results A total of 92 final-year MBBS students were enrolled in the study. There was no statistically significant difference between the performance of the study participants in the post-intervention MCQ test in the two groups [mean (standard deviation) scores, 13.4 (1.55) vs. 9.7 (3.49), P > 0.05], even after subgroup analysis for high scorers and low scorers. The total cost of sending the messages was less than Rs. 100. ConclusionThere was no statistically significant effect on cognitive performance following a supplementation of classroom teaching by SMS-based key messages. However, given the low cost of this methodology and the reported high acceptance of this method by students, there is a need for more well-planned studies to confirm these results.
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Status of Noncommunicable Disease Screening in an Urban Resettlement Colony in Delhi, India: A Descriptive Cross-Sectional Study p. 133
Ruchira Pangtey, Saurav Basu, Gajendra S Meena, Bratati Banerjee
DOI:10.4103/mamcjms.mamcjms_42_18 Background Noncommunicable diseases (NCDs) are responsible for more than two-third cases of premature mortality (30–69 years) in India. Screening for NCDs is the most effective means for detection of undiagnosed NCD cases and early treatment initiation that lowers morbidity and mortality due to these diseases. The objective of the present study was to assess the NCD screening status in an urban resettlement colony of Delhi. Materials and Methods A community-based cross-sectional study was conducted among residents of the area. Patients with preexisting hypertension and diabetes and aged below 30 years were excluded. The patients were further screened for hypertension by taking three separate readings using an aneroid sphygmomanometer. The Indian Diabetes Risk Score (IDRS) was calculated to evaluate diabetes risk. Results A total of 110 men and 103 women (N = 213) met the inclusion criteria. The mean (±standard deviation) age of the patients was 40 (±9.3) years. A history of previous screening for hypertension and diabetes was reported by 73 (34.2%) and 40 (35.4%) patients, respectively. A medium or high-risk of having diabetes mellitus as per the IDRS score was present in most (88.4%) patients. On current screening, nine (8.2%) men and nine (8.7%) women were identified as undiagnosed hypertension cases. Only four (3.8%) women had undergone a clinical breast exam, and just nine (8.7%) women ever had a Pap smear examination. Conclusion The present study shows that the current strategy of opportunistic screening for NCDs has been unable to reach large segments of vulnerable and at risk populations.
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zoom.png Coarctation of Aorta With Valvular Heart Disease: A Hybrid Approach p. 137
Ankit Jain, Prerit Agarwal, Subodh Satyarthy, Kuber Sharma, Muhammed A Geelani
DOI:10.4103/mamcjms.mamcjms_41_18 We describe the management of three patients with coarctation of aorta (COA) associated with valvular heart disease. All the three patients underwent initial balloon dilatation following which they underwent surgical correction of the valvular pathology. Staged approach in such diseases has better outcome in terms of morbidity and mortality. Both single-stage and two stage operations can be used. As surgical correction of COA is frequently associated with potential complications, we adopted the staged approach for better results. Background COA with valvular heart disease is generally a rare combination. Both these entities require correction which can be done simultaneously or as staged procedure. Objective To study the outcome of staged procedures in such patients. Materials and Methods We managed 3 patients with COA associated with valvular heart disease. Results All the 3 patients had uneventful post operative recovery. At the time of discharge gradients were <20 mm Hg across the coarctated segment. Post operative echocardiography (echo) after 3 months on follow up were normal. ConclusionSimultaneous surgical correction of COA along with valvular heart disease is associated with potential surgical and anesthetic complications. Hence staged procedures are preferred if the anatomy of coarctation is feasible for endovascular correction.
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CASE REPORTS Top
Anesthetic Considerations in a Child With IgG4 Disease p. 142
Summit D Bloria, Ketan Kataria, Ankur Luthra, Pallavi Bloria
DOI:10.4103/mamcjms.mamcjms_22_18 Immunoglobulin G4 (IgG4)-related disease is a relatively newly coined term for a disease which affects various body organs. There is tissue invasion of IgG4-positive plasma cells into tissues leading to various manifestations like lymph node enlargement, autoimmune pancreatitis, pulmonary manifestations, hepatic disease, and others. We describe the anesthetic management of a pediatric patient suffering from IgG4-related disease with systemic manifestations who underwent a ventriculoperitoneal shunt revision.
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zoom.png Emergency Cesarean Delivery in a Parturient With Intracranial Tumor: Anesthesiologist’s Challenge p. 145
Kapil Chaudhary, Sandeep Mehra, Kirti N Saxena, Bharti Wadhwa, Himanshu Sikri
DOI:10.4103/mamcjms.mamcjms_34_18 Anesthetic management of a patient having an intracranial tumor undergoing cesarean section is challenging because of a combination of factors including their diagnosis, physiological changes of pregnancy, fetal viability concerns and complexity of surgical and anesthetic interventions. The scenario is more challenging in emergency surgery as the time for optimization and multidisciplinary involvement is minimal. We discuss successful management of a term primigravida with intracranial tumor who presented for emergency cesarean delivery. The anesthetic challenges and the management options are discussed.
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zoom.png Ventriculoperitoneal Shunt-Associated Meningitis Caused by Candida auris: A Case Report p. 149
Rohit Chawla, Anuj Sud, Nadeem Ahmad, Chander Prakash Baveja
DOI:10.4103/mamcjms.mamcjms_35_18 Candida auris was first isolated in Japan in 2008. Since then, it has become an emerging global threat due to its role in outbreaks in healthcare facilities and its decreased susceptibility to multiple antifungal agents. We report a case of ventriculoperitoneal shunt-associated meningitis caused by C. auris in a patient who had a history of tubercular meningitis and hydrocephalus. The isolate was initially misidentified as Candida krusei based on purple-colored colonies on Modified HiCrome Candida Differential Agar but was finally identified as C. auris on VITEK-2 compact (version 8.01). The isolate had a high minimum inhibitory concentration (MIC) for fluconazole, whereas the MICs for other major classes of antifungals were low.
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zoom.png Intractable Chylothorax Following Mitral Valve Replacement in an Adult p. 152
Ankit Jain, Arindam Roy, Saumya S Jenasamant, Manish Jawarkar, Harpreet S Minhas
DOI:10.4103/mamcjms.mamcjms_46_18 Chylothorax after an open-heart surgery has previously been mentioned in the literature. We report this association in a young female post-mitral valve replacement surgery due to abnormal lymphatic channels. Medical management was conducted for 4 weeks. On failure of the conservative treatment, she underwent pleurectomy with suture ligation of the thymic gland remnants and pericardium for the chylothorax, which resolved following the redo surgery. This rare incidental variation in lymphatic drainage was responsible for refractory chylothorax, which otherwise could have been managed medically.
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IMAGES IN CLINICAL PRACTICE Top
zoom.png Multiple Osteolytic Lesions Due to Primary Hyperparathyroidism p. 155
Saurav Kumar, Lovekesh Kumar, Alpana Manchanda, Radhika Batra, Rajesh V., Anubhav Vindal, Anju Garg, Pawanindra Lal
DOI:10.4103/mamcjms.mamcjms_56_18
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LETTER TO THE EDITOR Top
Spontaneous Severe Hypoglycemia: Cause of Delayed Emergence p. 159
Divya Gahlot, Kirti N Saxena, Rahil Singh
DOI:10.4103/mamcjms.mamcjms_28_18
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MAMC Journal of Medical Sciences, a publication of Maulana Azad Medical College

Multidisciplinary Dentistry

Increasing cancer burden: Time to modify lifestyle behaviours
S Leena Sankari

Indian Journal of Multidisciplinary Dentistry 2018 8(2):55-56

Effect of direct administration of functional foods on oral flora in patients undergoing fixed orthodontic treatment
T Jaya Chandra, Anoosha Manda

Indian Journal of Multidisciplinary Dentistry 2018 8(2):57-60

Introduction: Orthodontic treatment facilitates the growth of pathogens and leads to white spot lesions and caries formation. This study was carried out to compare the efficacy of probiotics, prebiotics, and symbiotics on the salivary levels of Streptococcus mutans, Lactobacillus, and Bifidobacterium. Materials and Methods: Saliva samples were collected from the patients who were undergoing comprehensive orthodontic treatment at two different time intervals, baseline (T0) and postintervention (T1) that is 1 month after administration of prebiotic, probiotic, and symbiotic bacteria, respectively, for Groups A, B, and C; placebo was included in Group D. Samples were inoculated on selective media, after incubation growth was identified. Colony counts were recorded in colony forming units per milliliter. Paired t-test, analysis of variance, and post hoc Tukey's honest significant difference test were used for analysis, and P < 0.05 was considered to be statistically significant. Results: Among the participants, S.mutans counts were found to be decreased (P < 0.05) and lactobacilli and bifidobacterium counts were found to be increased (P > 0.05). Conclusion: Short-term consumption of probiotics, prebiotics, and symbiotics had effectively reduced the S. mutans levels in the oral cavity with increased levels of Lactobacillus and Bifidobacterium when compared with the placebo group.

Oral cancer awareness and attitude toward its screening: A study among people with different occupations
Tathagata Bhattacharjee, Somnath Gangopadhyay

Indian Journal of Multidisciplinary Dentistry 2018 8(2):61-70

Background: The number of oral cancer cases is increasing in India. The prevalence of this disease is increasing in various occupational groups. Aims: This study aimed to assess the awareness of oral cancer and attitude toward screening and the prevalence of related habits and habit-related oral lesions among people with different occupations. Settings and Design: Sixteen closed-ended questions were used to assess the awareness of oral cancer. Responses were scored in accordance with the defined rules. Patients' attitude toward oral cancer screening was also assessed using ten additional questions under four headings. Information regarding the oral habits was recorded using the WHO steps questionnaire. Materials and Methods: Distribution of occupation in the study population was categorized as per the International Standard Classification of Occupations-08 structure and all the study samples ware clinically examined to diagnose any habit-related oral changes. Statistical Analysis Used: Student's independent sample's t-test was applied to compare normally distributed numerical variables between groups; unpaired proportions were compared by Chi-square test or Fisher's exact test. One-way analysis of variance was used to compare the means of three or more samples for numerical data. Results and Conclusion: A statistically significant difference (P = 0.0001) in general awareness of oral cancer was seen among various occupational groups. The attitude toward oral cancer screening was assessed and found no statistically significant results, which signifies that significant motivation for oral cancer screening is required in different occupational workplaces.

An online survey about awareness and motivation regarding periodontal health in Maharashtra
Priyanka Gangadhar Kapse, Ramreddy K Yeltiwar, Pallavi K Patil, Kaustubh S Thakare

Indian Journal of Multidisciplinary Dentistry 2018 8(2):71-75

Context: Chronic periodontitis is multifactorial disease with high prevalence rate in India. Motivation in periodontitis patients is thought to play a major role in influencing periodontal health in this patient. This online study focuses on different areas for motivation such as age, financial, and educational status including different health-care professionals. Aims: The purpose of this study was to evaluate awareness, behavior, and motivation regarding periodontal disease in general population and health professionals (dental and medical) in Maharashtra state with aim and objectives to assess the patient's knowledge and concern about the importance of self-care in controlling periodontal disease. Settings, Design, Subjects, and Methods: The study sample consisted of 1001 participants ranging between 20 and 60 years old. The questionnaire was prepared and circulated by the mobile application (WhatsApp). A questionnaire consisting of multiple choice questions was used as assessment tool and its content evaluated the patients profile, their knowledge about periodontal disease, the dental professional's commitment to instruct the patients toward their behavior concerning oral hygiene along with their perception of the importance of self-care for disease control and knowledge and motivation in dental and medical professionals about periodontal health. Statistical Analysis Used: The completed questionnaires were then analyzed statistically on survey monkey website to obtain the results through tables and graphs of the frequency distribution. Results: The result of this study shows basic awareness about oral hygiene in educated population but an acute lack of oral hygiene awareness and limited knowledge of oral hygiene in general population. Conclusions: Hence, there is an urgent need for comprehensive educational programs to promote good oral health and impart education about the correct oral hygiene practices. There is need for awareness not only in the general population but also in health-care professionals too.

Evaluation of knowledge and attitude about gingival displacement materials and techniques among dental practitioners
Vijeta Gajbhiye, Rajlakshmi Banerjee, Usha Radke, Anuj Chandak, Priti Jaiswal

Indian Journal of Multidisciplinary Dentistry 2018 8(2):76-81

Statement of Problem: Edentulism is a condition that critically affects the quality of life of patients by compromising function as well as esthetics. Fixed partial dentures have been a treatment of choice to replace missing teeth. Despite its various advantages, failures are not uncommon. Recording accurate impressions is a crucial prerequisite to ensure the success of prosthesis. Gingival displacement, especially in restorations with subgingival margins, is extremely important to record the accurate impressions of the finish line. Aim and Objectives: The purpose of the study was to evaluate the knowledge and attitude about gingival displacement materials and techniques among dental practitioners in Nagpur region. Materials and Methods: A survey consisting of 15 questions regarding gingival deflection method was distributed among 200 dental practitioners. The participants were approached personally with the printed questionnaire and through E-mail. Results: The survey showed that approximately 86% of the dental practitioners practicing in Nagpur region did not perform gingival displacement before making impressions. Out of 16% of the dentists who perform gingival displacement, only 10% of them were prosthodontists. The most common method used for gingival displacement was retraction cord. Better techniques such as cordless gingival displacement were used by only 6% of the dentists because of lack of knowledge and technique sensitivity of these materials. Financial concerns may also be a deterrent for performing gingival displacement in such cases. Conclusion: Hands-on experiences on gingival displacement need to be imparted at the undergraduate level and the importance of gingival displacement for the success of prosthesis needs to be conveyed to dental practitioners, so as to bring about a change which results in a better rehabilitation of patients with partial edentulism.

Effect of various luting agents on retention of cement-retained implant restorations with different modifications – An in-vitro study
S Mohammed Imthiyas, Bala Subramanian, Prabhu Karupiah, A Kirubakaran, VC Karthik, Suganya Ganesan

Indian Journal of Multidisciplinary Dentistry 2018 8(2):82-86

Introduction: Cement-retained restorations are the most common mode of attaining retention in implant prosthesis. Surface modifications can enhance the retention of the cement-retained implant restorations. Materials and Methods: A total of 45 copings (n = 45) were fabricated and divided into three groups based on the types of cements used: Group A – zinc phosphate cement, Group B – zinc polycarboxylate cement, and Group C – glass-ionomer cement. Each group was subdivided into three subgroups depending on the surface treatment employed: Subgroup 1 – unmodified copings (controlled group), Subgroup 2 – sandblasted copings, and Subgroup 3 – roughened abutment. The blocks with abutments on which the coping was cemented on them were locked on a universal testing machine. Results: The mean load required to debond the copings cemented with zinc phosphate cement under various surface modifications was found to be 154 N for unmodified copings, 184 N for sandblasted copings, and 171 N for roughened abutments. The mean load required to debond the copings cemented with zinc polycarboxylate cement under various surface modifications was found to be 212 N for unmodified copings, 325 N for sandblasted copings, and 390 N for roughened abutments, respectively. The mean load required to debond the copings cemented with Type 1 glass-ionomer cement under various surface modifications was found to be 302 N for unmodified copings, 413 N for sandblasted copings, and 412 N for roughened abutments. Conclusion: The retentive properties of the three types of cements tested in this study were statistically significant. Type 1 glass-ionomer cement shows the highest mean retentive strength, followed by zinc polycarboxylate and zinc phosphate cement. There was no statistically significant difference between the sandblasted and roughened abutment copings cemented with Type 1 glass-ionomer cement.

Use and application of computer and internet in dental education among students of Nagpur city
Sanjana Agrawal, Anita Rama Kahar, Usha Radke, Surbhi Pandagale, Priya Agrawal, Jayashree Joshi

Indian Journal of Multidisciplinary Dentistry 2018 8(2):87-93

Background: Computer and Internet has currently become most easily accessible vehicle for extracting and viewing the data to everybody. Each folk carry the Internet in our hand and use it in just one finger bit. In dental education, additional use of computer and Internet is not a story of happening once and whereas, it is a routine procedure. The computers and Internet is employed for teaching and learning purpose. For the students, the Internet is currently one in every of the foremost necessary sources of data for looking and resolving the queries in academics beneath the steering of revered colleges. Hence, we decided do conduct such study in three dental institutes of our Nagpur city. Aim: Assessment of computer and Internet use and its application in dental education among the dental students of three dental institutes of Nagpur city. Materials and Methods: A cross-sectional questionnaire survey was undertaken among the first to final BDS students of three dental colleges of Nagpur city. Results: One hundred and twenty (16.12%) of the participants use the Internet for searching information in dentistry. Three hundred and eighty-five (51.74%) of them use Internet for searching textbooks, videos, and literature. Three hundred and two (40.59%) of them prefer to read text from a book than computer. Conclusion: Majority of the dental students use computer and Internet for their studies. At the identical time students were not a lot aware of e-books. They conjointly preferred to read text from a book. The preclinical year student's angle toward the use of computer and Internet was found to be more than clinical year students.

Software in forensic odontology
P Anuja, Nagabhushana Doggalli

Indian Journal of Multidisciplinary Dentistry 2018 8(2):94-100

Let us now pause for a moment of science!! Technological advances are becoming more and more important in forensic sciences these days. Forensic odontology plays a major role in identifying those individuals who cannot be identified visually or by other means. Various software, such as Windows Identification, Disaster and Victim Identification (DAVID) and automated dental identification system (ADIS), have been developed that greatly help in easier identification. With the development of various software such as Adobe Photoshop and Dentascan, it is possible to scan the dentition of a deceased within minutes. The various post processing software like Adobe Photoshop (Adobe Systems Incorporated, San Jose, California) allows visualization of the data adapted to every possible antemortem X-ray for identification. This review describes the significance of various software used in forensic odontology.

Nanorobotic wonders: A revolutionary era in periodontics
Pratiksha Bordoloi, Sheikabba Shahira, Amitha Ramesh, Biju Thomas

Indian Journal of Multidisciplinary Dentistry 2018 8(2):101-105

Greatness does not come in size. Surprises come in small packages. Robots have recently been introduced to undertake basic surgical procedures, and with the help of nanobiotechnology, another dimension of robotics has been developed as NANOROBOTS. Oral cavity is the mirror of the overall health of an individual. The various chronic inflammatory oral diseases influence the systemic health of an individual and vice versa. Various treatment modalities have been introduced for the prevention and management of periodontal disease. The introduction of nanorobots may possibly maintain the comprehensiveness of oral health. The dental application of nanorobots is leading to the emergence of nanodentistry. Nanorobots induce oral analgesia, desensitize tooth, and are also used in preventive, restorative, and curative procedures and major tooth repair. Treatment opportunities in periodontics are hypersensitivity cure, dentiforobots, bone replacement materials, nanoimplants, nanolasers, etc. Hence, the aim of this review article is to emphasize the use and the future scope of nanorobotics in periodontics.

Role of acidic additives in noncaloric sweeteners in causation of dental erosion
Avijit Avasthi

Indian Journal of Multidisciplinary Dentistry 2018 8(2):106-110

Dental erosion is a nondestructive carious process, slowly dissolving tooth structure because of extrinsic, intrinsic, and idiopathic causes, resulting in painless loss of tooth structure without the involvement of microorganisms. Polyols/noncaloric sweeteners are promoted extensively owing to cariostatic action and low-glycemic response, but pose a risk of dental erosion because of acidic additives incorporated into sugar-free products which cause demineralization of enamel. Erythritol, sorbitol, mannitol, and xylitol are some of the polyols publicized in maintaining good oral health by the American Dental Association. A review of the existing literature was done by searching through databases such as PubMed, EBSCO, Hinari, and Sage on noncaloric sweeteners from February to end of May 2016 using keywords noncaloric sweetener, polyols, dental erosion, casein phosphopeptide (CPP) and amorphous calcium phosphate (ACP), nanohydroxyapatite, and prevention of erosion. Novel preventive strategies by infusing CPP ACP, milk protein casein, and fluoride into sugar-free formulations may resolve the cause of dental erosion.

Multidisciplinary Dentistry

Sahel Medical Journal

Growth patterns of preterm infants: A prospective study in an indigenous African population
Rosena Olubanke Oluwafemi, Moses Temidayo Abiodun

Sahel Medical Journal 2018 21(4):181-188

Background: Optimal growth of preterm infants reflects their overall health status; however, indigenous growth charts are rarely available to monitor them adequately in infancy. Objectives: The aim of this study was to describe growth patterns of preterm infants and to generate percentile charts as well as relevant predictive equations for expected weight-for-age in their various birth weight categories. Materials and Methods: This was a prospective, analytic study. Anthropometric measurements of eligible consecutive preterm babies were monitored biweekly/monthly in infancy. Temporal changes in body weights and occipitofrontal circumferences (OFCs) were presented graphically. The Pearson's correlation coefficient was done to derive predictive equations. LMS chartmaker light version 2.54 (Medical Research Council, UK) generated percentile charts. P < 0.05 was considered statistically significant. Results: A total of 154 preterm infants were recruited during the study period, with a male-to-female ratio of 1:1.5. Their mean gestational age (GA) was 31.3 ± 2.4 weeks, and mean birth weight was 1510.8 ± 347.5 g. Average daily weight gains were 9.4, 17.4, and 20.0 for extremely low birth weight (ELBW), very LBW (VLBW), and LBW, respectively, in the 1st month (F = 1.733, P = 0.183). The peak weight gain period occurred at the 4th month for ELBW (28.3 g/day), 5th month for VLBW (38.3 g/day), and 7th month for LBW (38.3 g/day). There was a strong positive correlation of their body weight with their postnatal age (y = 505.6x + 1511.5; R2 = 0.92) as well as OFC with age (y = 1.33x + 29.94; R2 = 0.94). Growth charts for weights and OFCs were generated showing 5th, 50th, and 95th percentiles. Conclusion: The preterm infants gained weight with increasing postnatal age following an initial weight loss in the early neonatal period. Their relative growth velocities were similar in all birth weight categories.

The use of hydroxycarbamide in children with sickle cell anemia
Hafsat Rufai Ahmad, Jamilu Abdullahi Faruk, Adekunle Matthew Sobowale, Amos Solomon, Adebiyi Niyi Mustapha, Olufemi Gboye Ogunrinde

Sahel Medical Journal 2018 21(4):189-193

Background: Although hydroxycarbamide (hydroxyurea [HU]) has been in use for decades in both adults and child populations with sickle cell disease (SCD), its reported use has remained low in Africa and Nigeria where the largest number of SCD patients reside. Availability, cost, and concerns about safety and efficacy are some of the challenges to its use. Objectives: This study highlights the experience of using HU for children with sickle cell anemia in Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: A descriptive, retrospective observational study of children is presented. Demographic, clinical, and laboratory features of children on HU, the indications for therapy and adverse clinical events encountered were analyzed. Results: A total of 165 children were treated with HU over a 4-year period, their ages ranging between 0.9 and 17 years. A total of 85 (47.5%) had HU for >12 months, while 61 (34.1%) were on treatment <11 months, while 19 (10.2%) were lost to follow-up. There was a significant increase in the weight, height, fetal hemoglobin, mean corpuscular volume, and a significant reduction in white cell counts; with no differences in the packed cell volume, hemoglobin concentration, creatinine, alanine transaminase, and bilirubin levels. Adverse events and/or comorbidities were reported in 48 (56.5%) patients, while one patient discontinued treatment because of skin rash. Conclusion: This study highlights the increased utilization of HU among children in an African region, the observed clinical events, and laboratory parameters. The benefits are demonstrable, and the drug-related organ toxicities appear minimal.

Oral manifestations of dengue fever
Sethuraman Govindaraj, Ramesh Jayaraman, M Jonathan Daniel, Saravanan Subbiah, Srinivasan Subramanian Vasudevan, Jimsha Vannathan Kumaran

Sahel Medical Journal 2018 21(4):194-198

Background: Dengue is a life-threatening viral infection which has become an epidemic in India in the postmonsoon period (August–November). It mostly associated with nonspecific fever and rashes, arthralgia, myalgia, and thrombocytopenia in severe cases. Objective: This study aimed to study the oral manifestations of dengue fever and to observe the various features of oral presentation then to validate the significance and importance of oral manifestation in the diagnosis of dengue fever. Materials and Methods: Patients meeting the inclusion criteria were subjected to detailed history, oral examination, and relevant investigations. Results: Intraoral manifestations were present in 24 (48%) patients, anf these included petechiae (29.2%), bleeding gums (16.6%), ulcer (4.2%), dryness of mouth (4.2%), and combined features (45.8%). Extraoral manifestations were present in 4% of the cases. Conclusion: This study highlights the thrombocytopenia related oral haemosrrhagic manifestations of dengue fever.

Target organ damage among subjects with high-normal blood pressure in a Nigerian tertiary health institution
H Saidu, KM Karaye, BN Okeahialam

Sahel Medical Journal 2018 21(4):199-203

Background: There is paucity of data on the relationship between high – normal blood pressure (BP) and target organ damage (TOD) in sub-Saharan Africa including Nigeria. This study therefore, aimed to assess target organ damage (TOD) among subjects with high – normal BP in comparison with hypertensives and subjects with optimal BP. Materials and Methods: The study was cross-sectional and comparative conducted at Aminu Kano Teaching Hospital, Kano on eligible subjects aged 18 years and above. Three groups comprising of randomly selected subjects (high -normal (group 1), hypertension (group 2) and optimal BP (group 3)), with each group having 100 in number were studied. Funduscopy and relevant investigations including transthoracic echocardiography were carried out. High – normal BP was defined as systolic BP of 130 -139mmHg and/or diastolic BP of 80-89mmHg. Results: The mean age of subjects in group 1 was 27.32 ± 8.20 years and 60% were female, 34.04±6.25 years for group 2 and 53% were female, and 52.81 ± 13.3 years for group 3 and 56% were female (P = < 0.001). The most prevalent TOD was left ventricular hypertrophy, present in 62% of hypertensives, 14% of those with high-normal BP and 2% of those with optimal BP(P = <0.001). Micro albuminuria and slight increase in creatinine were found in 12.9% and 6% of subjects with high-normal BP; 25.7% and 25% of hypertensives and 4.1% and 3% of subjects with optimal BP. The study found a significant progressive increase in both cardiovascular disease risk factors and target organ damage (TOD) as BP increased across the blood pressure categories from optimal BP to high – normal BP and to hypertension (P = <0.05). Conclusion: Subjects with high-normal BP had significantly higher prevalence of both TOD and cardiovascular disease risk factors than those with optimal BP but lower than hypertensives, suggesting that efforts to control BP should start early to reduce the complications of high BP.

Snakebites in a Nigerian children Population: A 5-year review
Ikenna Kingsley Ndu, Benedict Onyeka Edelu, Uchenna Ekwochi

Sahel Medical Journal 2018 21(4):204-207

Background: Snakebite envenomation is a worldwide problem, which is an important cause of death in the developing countries and still remains a neglected public health problem. Children sustain more severe toxicity from envenomation compared to adults and thus have different outcomes. Objectives: This study was carried out to review the demographics, risk factors, interventions, and outcomes of snakebite victims in the pediatric age group in Enugu, Southeast Nigeria, to improve the existing database. Materials and Methods: This was a descriptive, retrospective study conducted at the children emergency room (CHER) of Enugu State University Teaching Hospital (ESUTH), Enugu. The admission records of all the children that were admitted into CHER of ESUTH over a 5-year period (January 2012 to December 2016) were reviewed. Analysis was mainly descriptive. Frequency distributions of all relevant variables were reported as tables and prose. Test of significance for discrete variables was done using the Chi-square test. P <0.05 was regarded as statistically significant. Results: There were 5182 admissions with 13 cases of snakebite, giving a prevalence rate of 0.25%. Late presentation was significantly associated with longer duration of hospitalization (P = 0.026, χ2 = 4.952). Five (30.8%) patients had complications distributed as follows: one gangrenous limb (7.7%), one necrotic ulcer (7.7%), and three compartment syndromes (23.1%). Prehospital visit interventions included visit to the native doctor, local incision, application of herbs, tourniquet, and black stone application. One of the patients died, giving a case fatality rate of 7.7%. Conclusions: The prehospital emergency interventions given to snakebite victims still reflect practices that are harmful. It is possible that the majority of snakebite cases in our environment do not present to the health facilities. More efforts are required to improve the health-seeking behavior and emergency interventions for snakebite victims.

Pattern of hearing loss in a tertiary hospital in the North Western Nigeria
Iliyasu Yunusa Shuaibu, Dotiro Chitumu, Ibrahim Babatunde Mohammed, Nurudeen Adebola Shofoluwe, Mohammed Aminu Usman, Aminu Bakari, Lateef Kunle Lawal

Sahel Medical Journal 2018 21(4):208-212

Background: Hearing impairment is a major public health problem in developing countries. According to the World Health Organization, approximately 15% of the world's adult population has some degree of hearing loss. About one-third of those who are affected have disabling hearing loss and two-third of them live in developing countries. Aim: This study aims to determine the causes and pattern of hearing loss in Zaria, North Western Nigeria. Materials and Methods: This was a retrospective study conducted at ear, nose, and throat unit of Ahmadu Bello University Teaching Hospital Zaria, Kaduna Nigeria. The hospital is a tertiary health-care facility in North Western Nigeria and is a referral center to many primary, secondary, tertiary and private health facilities in Nigeria. The records of all patients who were managed for hearing loss in our unit over a period of 5 years between January 2011 and December 2015 were reviewed. Information obtained from the case files included demographic characteristics, main presenting symptoms, and causes of hearing loss. Findings of pure tone audiograms, tympanograms, and otoacoustic emission were also recorded. The data obtained were analyzed using statistical package for Social Science Version 21. Results: Of the 277 patients who presented with hearing loss, only 144 met the inclusion criteria. There were 86 (59.7%) males and 58 (40.3%) females with sex ratio (M:F) of 1.4:1. The mean age was 29.9 years with standard deviation of ±2.18. The most common cause of hearing loss was presbyacusis 24 (16.7%) followed by ototoxicity 14 (9.7%), most of the patients 91 (63.2%) had bilateral hearing loss while 53 (36.8%) had unilateral hearing loss. Majority 112 (77.8%) had sensorineural hearing loss, followed by 24 (16.7%) conductive and mixed 8 (5.5%). Majority of the patients 94 (64.3%) had mild to moderately severe with the remaining 50 (34.7%) having severe to profound hearing losses, respectively. Tympanometric findings showed that 118 (90.8%) and 11 (8.5%) had Types A and B tympanograms, respectively. Conclusion: Majority of the patients were adult with bilateral mild to moderately severe sensorineural hearing loss. Age-related hearing loss was the most common cause of hearing loss followed by ototoxicity.

Morbidity and mortality profile of patients seen in medical emergency unit of a Teaching Hospital in Nigeria: A 4-year audit
Bello Yusuf Jamoh, Sani Atta Abubakar, Sani Muhammad Isa

Sahel Medical Journal 2018 21(4):213-217

Background: Ahmadu Bello University Teaching Hospital (ABUTH) Zaria is strategically located to serve as referral center for most stable and emergency cases in the northwestern part of Nigeria. Patients also come on self-referral. Objective: This study aimed to describe the pattern of medical presentation and outcomes at the emergency unit of ABUTH over a 4-year period. Materials and Methods: A review of medical admissions into the Emergency unit of ABUTH, Zaria, between January 2013 and December 2016 was carried out using the case records of patients as well as register of admissions and discharges, information obtained were entered into a predetermined questionnaire. Results: The patients admitted during the period numbered 5193, with age range of 15–92 years. There were 2895 (56.0%) males and 2298 (44.0%), with a male-to-female ratio of 1.3:1. Emergencies attributable to infectious diseases occurred with the highest frequency (20.6%), followed by gastrointestinal (20.5%), renal (14.5%), endocrine (13.8%), respiratory (12.4%), cardiac (9%), neurological (2.8%), and hematological (1.1%). There was a significantly (P < 0.001) higher occurrence of noncommunicable diseases (71.5%) than communicable diseases (28.5%), as well as higher male cases in renal, respiratory, hematological emergencies (P < 0.05). There were more admissions in the wet season, (April to September) while the October to January period consistently recorded the low admission rates. An increasing trend in emergency medical admissions was observed, being highest in the year 2016. The median duration of stay was 4.5 days (range of 0–12 days). The outcomes of admission revealed 470 (9%) deaths, 2012 (37%) direct discharges, and 2801 (54%) transfers to male or female medical wards. Cases of tetanus had the highest case fatality rate (45%) while hypertensive emergencies had the lowest (4%). Conclusion: There is a rising trend of communicable as opposed to non-communicable diseases' emergencies in Zaria. Of the non-communicable diseases, incidence of gastro-intestinal emergencies was the highest while that of haematology was the least. The intra-hospital mortality rate attributable to medical emergencies is relatively lower in Zaria.

Turnaround time for electrolytes, urea, and creatinine in a clinical laboratory
Ekiye Ayinbuomwan, Tomi Mathew Adaja

Sahel Medical Journal 2018 21(4):218-221

Background: Timeliness is expressed as the turnaround time and is often used by the clinician as a benchmark for laboratory performance. Clinicians depend on fast turnaround time to achieve early diagnosis and treatment of their patients and early patient discharge from emergency departments or hospital in-patient services. Determination of the turnaround time would enable a critical self- appraisal of our laboratory services and improve our turnaround time. Objective: This study assessed the turnaround time for electrolytes, urea and creatinine tests from the emergency departments of the hospital. Materials and Methods: An observational study was conducted between September and October 2016 amongst patients from the Intensive Care Unit, Accident and Emergency Department and Children Emergency Room, whose blood specimens were received at the Chemical Pathology Department for emergency electrolytes, urea and creatinine tests. A total of 122 specimens were randomly selected and the average time taken to complete each phase was measured and the overall turnaround time calculated. Data was analysed using statistics software SPSS (version 13.5). Results: Audited cases consisted of 20 (16.4%) specimens from the Intensive Care Unit, 40 (32.8%) from the Children Emergency Room and 62 (50.8%) from the Accident and Emergency Department. The average turnaround time for the Accident and Emergency Department, Intensive Care Unit, and Children Emergency room were 6.5hours, 4.2hours and 5.2hours respectively. Conclusion: This study revealed that the turnaround time for electrolytes, urea and creatinine for patients in the emergency units is quite long and requires some improvement which could be done with the use of Laboratory Information System to track specimens from the various emergency units of the hospital.

Multi-organ dysfunction syndrome as the first presentation of acute brucellosis, a case report and literature review
Ibrahim Masoodi

Sahel Medical Journal 2018 21(4):222-226

Multiple organ dysfunction syndrome (MODS) is a continuous process with incremental degrees of physiologic derangements in individual organs. The alteration in organ function can vary widely from a mild degree of organ dysfunction to completely irreversible organ failure. MODS, as defined, is a clinical syndrome characterized by the development of progressive and potentially reversible physiologic dysfunction in two or more organs or organ systems that are induced by a variety of acute insults, including sepsis. The cornerstone in the management remains correction of the triggering agent. The clinical scenario of a young male who presented with progressive shortness of breath, renal failure, and epistaxis (MODS) at presentation is discussed in this report. The diagnosis of this patient was clinically quite challenging. On evaluation, he proved to have multi-organ failure due to Brucella melitensis. The patient improved with conventional B. melitensis treatment. The Brucella infection is a male predominant disease and frequently presents with typical symptoms of fever, fatigue, etc., and the diagnosis often is straightforward, but the reports of atypical presentation have been described in the literature. The heaviest disease burden of B. melitensis lies in countries of the Mediterranean basin and Arabian Peninsula. However, the disease is not uncommon in India, Mexico, and Central America. Hence, clinicians need to be aware of this clinical entity all over the globe. The report of the case and brief review of literature are presented in this report.

Benefits of human parvovirus B19 testing in sickle cell anemic patients and blood donors in Nigeria
Idris Abdullahi Nasir, Maryam Muhammad Zakari, Adamu Idris, Abdurrahman Elfulaty Ahmad

Sahel Medical Journal 2018 21(4):227-228

Sahel Medical Journal

Oral manifestations of dengue fever

Oral manifestations of dengue fever
Sethuraman Govindaraj, Ramesh Jayaraman, M Jonathan Daniel, Saravanan Subbiah, Srinivasan Subramanian Vasudevan, Jimsha Vannathan Kumaran

Sahel Medical Journal 2018 21(4):194-198

Background: Dengue is a life-threatening viral infection which has become an epidemic in India in the postmonsoon period (August–November). It mostly associated with nonspecific fever and rashes, arthralgia, myalgia, and thrombocytopenia in severe cases. Objective: This study aimed to study the oral manifestations of dengue fever and to observe the various features of oral presentation then to validate the significance and importance of oral manifestation in the diagnosis of dengue fever. Materials and Methods: Patients meeting the inclusion criteria were subjected to detailed history, oral examination, and relevant investigations. Results: Intraoral manifestations were present in 24 (48%) patients, anf these included petechiae (29.2%), bleeding gums (16.6%), ulcer (4.2%), dryness of mouth (4.2%), and combined features (45.8%). Extraoral manifestations were present in 4% of the cases. Conclusion: This study highlights the thrombocytopenia related oral haemosrrhagic manifestations of dengue fever.

Oral manifestations of dengue fever