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   Table of Contents - Current issue
September-December 2022
Volume 12 | Issue 3
Page Nos. 215-332

Online since Thursday, September 15, 2022

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Combatting drug-resistant tuberculosis in the midst of the ongoing COVID-19 pandemic: A formidable challenge for Bangladesh Highly accessed article p. 215
Tahmina Joy Rashid, Mainul Haque
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Emergency computed tomography scans in trauma: Where radiology is lacking the clinician fills the gap! p. 218
Priyashini Parag, Timothy Craig Hardcastle
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Does provision of antenatal care, post-natal care and perinatal care reduce maternal, neonatal and child mortality? With special attention towards Bangladesh situation in global perspective Highly accessed article p. 220
Badar Uddin Umar, Adnan Abdullah, Kona Chowdhury, Rahnuma Ahmad, Mainul Haque
The present review was intended to explore the effectiveness of perinatal services such as antenatal care (ANC) and post-natal care (PNC) on the health indicators such as maternal, child and neonatal mortality. Globally, indicators are considered very important in determining the health status and the overall performance of a country's healthcare system. A literature search was conducted using maternal mortality, child mortality, neonatal mortality, ANC and PNC in the PubMed, Google, Academia, The Lancet and Journal of the American Medical Association databases. Globally, implementing integrated perinatal care services has brought positive changes in the maternal, child and neonatal mortality indices. The United Nations (UN) is committed to improving the overall living conditions in all countries, significantly improving the population's health status. The UN came up with eight Millennium Development Goals in 2000, aiming to eliminate poverty and increase development in member states. The World Health Organization was a partner in implementing these goals. Later, the UN introduced 17-fold Sustainable Development Goals in 2015 as a blueprint for peace and prosperity for all citizens towards a better future by 2030. As a result, many countries have experienced positive changes in most indicator areas, including service utilisation, maternal mortality and child mortality. Some Sub-Saharan African and South Asian countries are progressing, however, slowly.
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Neurological manifestations of coronavirus disease 2019 hospitalised patients in Punjab, India p. 231
Zahoor Ahmad Parry, Binafsha Irshad Khanday, Zubair Ahmad Khwaja
Introduction: Coronavirus disease 2019 (COVID-19), the disease linked to severe acute respiratory syndrome coronavirus-2, is a widespread infectious disease. Coronaviruses cause multiple systemic infections, but neurological involvement has been reported very rarely. Materials and Methods: The present study is a single-centre prospective study conducted during the COVID-19 pandemic from November 2020 to April 2021, at Mogamedicity Superspeciality Hospital, Punjab, India. All COVID-19 patients with de novo neurologic manifestations were eligible to take part in the study. A total of 810 confirmed COVID-19 patients were enrolled for the study. Demographic features and initial clinical manifestations were noted, and patients were followed up during the hospital stay for the development of any new neurological signs and symptoms. For analytical purposes, neurological presentations were grouped into the central nervous system, peripheral nervous system and musculoskeletal system manifestations. Appropriate laboratory testing was employed as required on a case-to-case basis. Results: In this study, the mean age of the patients was 46.6 ± 15.5 years. Five hundred and fifty two (66.9%) patients were male, while 268 (33.1%) were female. Neurological illness was a primary manifestation in 48 (6%) cases. These included encephalopathy (n = 30), ischaemic stroke (n = 4), Guillain–Barre syndrome, (n = 2), facial nerve palsy (n = 4) and encephalitis (n = 1). The most common neurological symptoms were headache (284 [35%]) and hyposmia (78 [9.6%]), followed by encephalopathy (68 [8.3%]). More serious complications such as seizures (14 [0.7%]) and stroke (18 [2.2%]) were also seen. Conclusion: COVID-19 can present with a neurological illness, and we should remain vigilant to the possibility of neurological presentation of COVID-19 that can be thrombo-embolic, inflammatory or immune-mediated.
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To study the effectiveness of umbilical cord blood transfusion in neonates at tertiary health care centre p. 235
Shoaib Beg Mirza, Deepak Dwivedi, Shabd Singh Yadav, Naresh Bajaj
Introduction: Blood transfusions (BTs) are often required by neonates for different indications. There is usually a deficiency of available blood because of the non-availability of donors, lack of awareness, irrational demand, poor supply chain management system, etc., especially in developing countries. This study was done to determine the usefulness of umbilical cord blood (UCB) as an alternative to adult blood (AB) in neonates and to compare the change in haematological parameters after transfusion and compare outcomes. Materials and Methods: It was a prospective interventional study of UCB transfusions given to neonates requiring blood. UCB was collected in the labour room, under all aseptic precautions, and pretesting was done in the blood bank. Neonates fulfilling inclusion criteria were included. UCB and AB were given as per availability and consent. Post blood analysis was done after 6 h of transfusion watched for reactions. Outcomes such as death, discharge and duration of hospital stay were analysed. Results: A total of 91 BTs were performed, out of which 34 received UCB and 57 with AB. The mean rise of haemoglobin in UCB transfused patients was 2.01 g/dl. Conclusions: In neonates requiring BT, whole UCB is a good and safe alternative to whole AB.
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Cytomorphological analysis of urinary cells among active and passive cigarette smokers in South-West, Nigeria p. 239
Ayodeji Blessing Ajileye, Frederick Olusegun Akinbo
Introduction: Cigarette smoke contains thousands of identified chemicals, among which sixty-nine (69) of these chemicals are known to be poisonous to humans and are capable of causing cancer in any part of the body. This study was conducted to evaluate the cytology of urinary cells among active and passive cigarette smokers in South-Western Nigeria. Materials and Methods: Urine samples were collected from 250 active cigarette smokers and 200 passive cigarette smokers who live in South-Western, Nigeria. The urine specimen was collected from participants and processed using the standard technique for microscopic examination. Smears were stained with haematoxylin and eosin and Papanicolaou stain. Results: The urinary smears of passive cigarette smokers revealed normal superficial squamous cells, transitional cells, cast, necrotic debris and mild inflammatory cells, while that of active cigarette smokers revealed high cellular turnover, protein casts, dysplastic epithelial cells and atypical urothelial cells with degenerative features. Conclusion: On the basis of this study, the cytomorphological analysis of urinary smears among active cigarette smokers revealed cytopathological features which connote the harmful effects of the chemical constituents present in cigarette smoke.
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Difficulties encountered during fixation of trochanteric fractures with proximal femoral nailing: A prospective analysis of 200 cases at a tertiary care centre in North-West India p. 245
Lokesh Thakur, Sunny Dua, Sunil Kumar Raina, Bhanu Awasthi
Introduction: Proximal femoral nailing (PFN) compares favourably with dynamic hip screw in terms of surgical time, intra-operative blood loss and lag screw cut out in unstable inter-trochanteric fracture. However, data on difficulties faced during the fixation process are lacking. Therefore, the study was planned with the aim to identify difficulties encountered during fixation of trochanteric fractures with PFN in the patients. Materials and Methods: Two hundred patients with trochanteric fractures aimed for the operative procedure with PFN were included in the study. Patients with associated fracture of neck of femur, the shaft of the femur of the same side, with polytrauma, with multiple fractures, with pathological fractures and/or unwilling to participate in the study were excluded. Bone mineral density was evaluated using Singh's index. Fixation of trochanteric fractures was done using PFN. Results: More than 70% of the study participants were elderly, 53% of the participants were males, while 91% of the total participants belonged to a rural region. Hypertension was the most common comorbidity in 21% of the patients, followed by anaemia (14.5%) and diabetes (9%). 73% of the patients had grade 3 Singh's index. 53.5% of the patients had intra-trochanteric left femur while the remaining 46.5% of the patients had intra-trochanteric right femur. The reduction was the most common difficulty (26%) followed by entry point difficulty (21%) and guidewire passage (12.5%). No difficulty was observed in 29% of the patients. Conclusion: Achievement of good reduction between two main fragments without varus malalignment and placement of hip screw in a correct position are two important technical aspects that prevent most of the complications associated with these procedures.
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Evaluation of periodontal status amongst the diabetic patients visiting private dental clinic in ahmedabad using CPITN p. 249
Eshita Dasharathbhai Patel, Hiral Akshat Parikh, Riddhi Shah, Devarsh Mandaliya, Sagar Vishwkarama, Saurabh Nayak
Introduction: To determine the periodontal status and treatment needs using CPITN in a group of adult diabetic patients attending OPD in a private dental clinic in Ahmedabad. Materials and Methods: One hundred and two diabetic patients were screened by a single examiner according to the WHO criteria using a mouth mirror and CPITN probe. The patients were selected from the routine OPD after obtaining verbal consent for the same, and about 76 patients were included in the study, which was carried out for 9 months. Results: Results showed that the highest number of patients had code 3. The majority of sextants had code 2 and 3. Amongst all, 42 patients had a TN score of 2 and 33 had TN score of 3. 56–65 age groups had the worst periodontal status among all groups and required the highest periodontal treatment. Conclusion: The periodontal health of our diabetic patients reinforces the need to establish a comprehensive oral health promotion programme for diabetic patients with a multidisciplinary approach.
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A varied presentation of dermal adnexal tumours: An institutional study p. 254
Snigdha Sinha, Subhashish Das, Kalyani Raju
Introduction: Adnexal skin tumours are a heterogeneous group of uncommon tumours usually misdiagnosed clinically due to a huge variety of types and their variants. Histopathology usually helps in establishing the diagnosis. The study was conducted to analyse the morphological, clinical and histological features of adnexal tumours (ATs) of the skin at our centre over a period of 5 years. Materials and Methods: A retrospective study was conducted over a period of 5 years (January 2016–January 2021), comprising 85 ATs of skin diagnosed in the Department of Pathology, Sri Devaraj URS Medical College, Kolar, Karnataka, India. All the consecutively reported AT cases were reviewed and reclassified as ATs arising from sebaceous glands, hair follicles or sweat glands. The concordance of clinical and histopathological diagnosis was also assessed. Results: Most of the ATs were benign, with the head and neck being the most common location (61.15%), followed by the trunk (22.3%). Nearly 39% of the tumours were of hair follicle differentiation, 30% sweat gland differentiation and sebaceous gland tumours accounted for 31%. The most common varieties of tumours encountered in the present study included sebaceous cysts and pilomatricoma. The concordance between the clinical and histopathological diagnosis was found to be 50% approximately. Conclusion: Histopathology is the gold standard for diagnosing ATs as they are often misdiagnosed clinically.
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Anatomic pattern and variations of the ilioinguinal nerve as it travels throughout the anterior abdominal wall: Cadaveric study p. 260
Ahmed Onayzan Alshammari, Fauwaz Fahad Alrashid, Anas Abdulqader Fathuldeen, Eyad Mohammed Khalifah, Abdalla Ahmed Elamin, Abubaker El Elhaj, Saadeldin Ahmed Idris
Introduction: Ilioinguinal nerve (IIN) is repeatedly damaged during surgeries as well as through the application of local anaesthesia to the lower abdominal wall. This study aimed to identify the variations of the IIN during its course in the anterior abdominal wall. Materials and Methods: A cross-sectional study on formalin-preserved cadavers was carried out after approval by the ethical committee, Alzaeim Alazhari University (January 2018–May 2020). Cadavers satisfied the inclusion criteria were dissected bilaterally to expose and map the IINs from their lateral emergence on the anterior abdominal wall to their termination in the midline in reference to the internal and external inguinal rings as well as the fixed bony landmarks. The collected data were compared on both sides using SPSS version 21.0. Results: Fifty-four IINs were identified (77 cadavers). Double nerve was observed in 8.44%. IINs derived from L1, L1-3 and L3 in 98.1%, 1.3% and 0.6%, respectively. On the right side, in 3 corpses, the nerves aberrantly ascend from L3 or L1-3, whereas this deviant was not seen on the left side. The mean distance from the umbilicus was 9.2 cm ± 1.1 cm (equal on both sides). The mean distance from the deep ring was 1.5 cm ± 0.4 cm, it was closed on the right compared to the left (P = 0.87). It emerges 0.9 cm–6 cm from the anterior superior iliac spine, this was closed on the right than the left (P = 0.9). It was not attached to the external oblique muscle on the right side, whereas it did in 3.2% on the left (P = 0.03). The mean distance from the superficial ring was 1.9 cm ± 0.8 cm, almost the same on both sides. The mean distance from the inguinal ligament was 2.4 cm ± 0.5 cm, it was closed on the right than on the left (P = 0.98). Its mean thickness was 1.97 mm ± 0.44 mm and 1.88 mm ± 0.43 mm on the right and left sides, respectively. Conclusion: IIN demarcates variants not generally quoted in anatomical manuals.
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Efficacy comparison of magnesium sulphate, ketamine and neostigmine adjuvants to bupivacaine 0.5% on onset, duration and quality of ultrasound-guided supraclavicular block characteristics for forearm surgery p. 266
Habib Nadimi-Bajandi, Esmail Moshiri, Hesameddin Modir, Mohsen Parsi-Khamene
Introduction: This study aimed to provide an evidence-based foundation for appraising the efficacy of magnesium sulphate, ketamine and neostigmine plus bupivacaine 0.5% on key supraclavicular block (SCB) characteristics made up of onset, duration and quality for forearm surgery. Materials and Methods: This double-blind trial enrolled ninety patients who were identified as having needed forearm surgery and been hospitalised in the Arak-based Valiasr Hospital, Iran, stratified participants into triad randomised groups receiving the aforementioned adjuvants. The basic requirements were met to incorporate the underneath groups' data to be recorded and analysed within SPSS release 20: (a) haemodynamic parameters (including mean arterial pressure/heart rate/oxygen saturation) documented at 5-min intervals until the end of surgery; (b) the onset and next to the duration of complete sensory and motor block, the time to administration of the patient's first post-operative analgesia and the overall dose of analgesic administered; (c) all block failures; (d) opioid consumption during post-operative 24 h and (e) pain score measured on a visual analogue scale throughout recovery time and scheduled post-operative times (2, 4, 8, 12 and 24 h). Results: Notwithstanding the shorter onset of sensory and motor block manifested in the magnesium sulphate group and longer duration of motor block in those receiving neostigmine regimen (P < 0.001), the findings endorsed strong support for the potential efficacy of ketamine in affording the longer duration of sensory block, better clinically meaningful pain relief at all scheduled times and diminished opioid consumption during 24 h (all P < 0.001). Conclusion: Bearing in mind the lack of complication needing to be thought of and the trial's clinical findings, which bespeak the shorter onset of the block (both sensory and motor) in the group receiving magnesium sulphate versus the longer duration of motor and sensory block in the neostigmine- and ketamine-treated groups, respectively, and diminished pain score and opioid consumption in the latter, all the adjuvants, thus, could be suggested to be contributed to achieving successful SCB in forearm fracture patients, depending on the patient's general condition and the anaesthesiologist's discretion.
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Trends and seasonal variations in human secondary sex ratio in Southwest Nigeria: A 10-year survey p. 271
Samson Taiwo Fakorede, Stephen Damilola Ojo, Kikelomo Mercy Shonde, Khalid Olajide Adekoya, Liasu Adebayo Ogunkanmi, Bola Oboh
Introduction: Secondary sex ratio is the number of live male births per 100 female births. In humans, the primary sex ratio, which is the sex ratio at conception, is expected to be 1:1 in natural populations based on the law of independent assortment of the X and Y chromosomes. This is not the case with the sex ratio at birth as it is largely affected by various social and cultural practices that it tends to bias towards one sex, with profound implications for population and demographic dynamics. Materials and Methods: We collected retrospective data of records of live births from three Southwestern Nigerian states, covering 10 years. The data were obtained from different Hospitals/Birth Centres from three states, i.e., Lagos, Ondo and Osun, between 2006 and 2017. Data analysis was performed to determine the monthly, quarterly, yearly and seasonal variation in sex ratios. Chi-square analysis was used to determine the significance of differences in sex ratios at P < 0.05. Results: Annual average sex ratios of 99.7, 105.6 and 106.0 were obtained for Lagos, Osun and Ondo, respectively, while the pooled data had a sex ratio of 104.2, indicating male preponderance. Sex ratios differ significantly according to season. Differences in sex ratio were significant during the dry season in Lagos and Osun states and in Ondo during the rainy season. Conclusions: Sex ratios from Southwest Nigeria are as diverse as other populations, with ratios ranging between 99.7 and 106.0.
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Comparison of the efficacy of supraclavicular block with bupivacaine (0.5%) combined with dexmedetomidine, granisetron and magnesium sulphate in sensory and motor block and haemodynamic parameters of patients in upper-extremity orthopaedic surgery: A randomised clinical study p. 277
Hesameddin Modir, Behnam Mahmoodiyeh, Amir Hossein Moradi, Fatemeh Mohseni, Amir Almasi-Hashiani
Introduction: Peripheral nerve block leads to effective pain control. Peripheral nerve blocks are used both in general anaesthesia and as regional anaesthesia alone. The aim of this study was to compare the characteristics of the supraclavicular block with bupivacaine (0.5%) in combination with dexmedetomidine, granisetron and magnesium sulphate in upper-limb orthopaedic surgery. Materials and Methods: This double-blind clinical trial was carried out on 105 patients who were candidates for upper-limb orthopaedic surgery in Valiasr Hospital in Arak. The patients were divided into three equal groups (dexmedetomidine, granisetron and magnesium sulphate) using the block method for randomisation. Mean arterial pressure, heart rate and arterial oxygen saturation every 5 min until the end of the surgery, onset and duration of sensory and motor block, mean opioid consumption in 24 h and post-operative pain during recovery and 2 h after surgery at 4, 8, 12 and 24 h were recorded. Data were analysed by SPSS.22 software. Results: The lowest heart rate at all times and the lowest blood pressure from 40 min to the end of surgery were observed in the dexmedetomidine group (P < 0.05). The time to the onset of sensory block and the time to the onset of motor block were shorter in the magnesium sulphate and dexmedetomidine groups, respectively. Moreover, the duration of the sensory and motor block was longer in the dexmedetomidine group (P = 0.0001). In addition, pain and amount of opioid consumption were lower in the dexmedetomidine group (P = 0.0001). Conclusion: Magnesium sulphate caused earlier onset of sensory block, while dexmedetomidine increased the duration of sensory and motor block. In the dexmedetomidine group, haemodynamic changes were made in the form of a decrease in heart rate and blood pressure, which, of course, did not require special treatment. As such, magnesium sulphate as an adjuvant is recommended to be used in cases where there is a requirement for the rapid onset of sensory block. Meanwhile, dexmedetomidine should be used as an adjuvant for the rapid onset of motor block and increase of the duration of sensory and motor block when taking into account the patients' physical conditions and the anaesthesiologist's discretion.
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DRD2 Gene-141C insertion/deletion polymorphism among schizophrenia patients: The first investigation in Palembang, Indonesia p. 283
Ziske Maritska, Fitri Fitri, Bintang Arroyantri Prananjaya, Raden Ayu Mulya Liansari, Nita Parisa, Mgs Irsan Saleh Hasani
Introduction: Schizophrenia remains one of the most common mental health disorders, affecting people worldwide. Its causes comprise environmental risk factors to genetic risk factors. One of the candidate genes for schizophrenia is the dopamine D2 receptor (DRD2) gene. There are several single-nucleotide polymorphisms found in the gene, with-141 C insertion/deletion polymorphism as one of the most commonly investigated polymorphisms. This study is the first to investigate the DRD2 gene-141 C insertion/deletion polymorphism among schizophrenia patients in Palembang, Indonesia. Materials and Methods: Eighty schizophrenia patients from the only national reference mental hospital in the South Sumatra area, Ernaldi Bahar Mental Hospital, participated in this cross-sectional study. DRD2 gene-141C insertion/deletion polymorphism (DD, DI and II) was detected using restriction fragment length polymorphism analysis. Results: The-141 C insertion or DD genotype was less frequent (n = 4; 5%) compared to the II genotype (n = 25; 31.25%) and-141 C deletion or DI (n = 51; 63.75%) as the most frequent genotype found. Conclusion: This study is one of the few studies in the Indonesian population investigating the DRD2 gene-141 C insertion/deletion polymorphism. With a small sample size in consideration, our findings suggest that this polymorphism is prevalent in the Indonesian population.
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Social media as a learning tool for the budding periodontist: A questionnaire survey p. 286
Riddhi Awasthi, Balaji Manohar, S Vinay, Santosh Kumar
Introduction: Social media is a web-based platform which has gained popularity amongst students for learning and enhancing their skills. Students are adapting to e-learning methods to enhance their clinical skills. The aim of this study was to evaluate the use of social media as an educational/learning tool amongst post graduates in periodontology. Materials and Methods: A cross-sectional study was conducted amongst post graduates pursuing periodontology in India. A validated questionnaire was used to explore the benefit of social media for enhancing the theoretical knowledge as well as the clinical skill of post graduates. Descriptive statistics, Kruskal–Wallis and paired and unpaired t-tests were performed for statistical analysis. Results: The survey included 485 students from the 1st to 3rd year of postgraduates. YouTube was the most used social media platform (87.6%), followed by Instagram (55.0%), Facebook (43.0%) and others. Social media was used for gaining theoretical knowledge (97.3%), pre-clinical guidance (77.4%) and for periodontal surgical skills (52.5%). Similar opinions and recommendations were also analysed. Conclusion: The present findings suggest that students report social media can be a valuable learning tool in postgraduate education if used as an adjunct. A proper understanding of social media resources can benefit both the theoretical and clinical knowledge of the postgraduates.
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Effects of the face mask on the skin during the COVID-19 pandemic in Saudi Arabia p. 292
Salim Ali Algaadi, Yazeed Abdulaziz A Almulhim, Yousef Mansour Y Alobaysi, Abdulrahman Mubarak Alosaimi, Marwan Shukri S Alshehri
Introduction: The use of face mask in these COVID-19 times has increased manifolds. This has led to various skin problems due to the adverse reaction caused by the mask. This study aimed to observe the skin effects of the face mask during the COVID-19 pandemic among individuals in Saudi Arabia. Materials and Methods: Cross-sectional study in different regions of Saudi Arabia with data collection was done using a self-administered online questionnaire in the adults above 18 years of age of both sexes. Results: The study involved 516 participants who were mostly young population with male predominance. In general, 37% of face skin reactions related to mask use, whereas 63% of participants did not notice any skin reaction from face mask wearing. Most of them wear surgical masks (85.5%), of which 36.7% of them reported adverse skin reactions (ASRs) related to surgical masks. Furthermore, using the mask for >4 h is approximately double the risk of skin changes, and a significant association has been found between the duration of mask use and ASRs. Finally, no significant association was observed between prolonged face mask use and aggravation of pre-existing skin diseases by face masks. Conclusion: The overall prevalence of skin reactions associated with face masks was 37%. The most frequent skin reaction was acne and itching symptoms, followed by acne alone. Regarding mask type, both surgical and cloth masks were associated with a significantly high incidence of ASRs, which was statistically significant.
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Determinants and bacteria associated with asymptomatic bacteriuria among women attending antenatal care service at muhoza health centre, Rwanda p. 298
Callixte Yadufashije, Agnes Ishimwe, Joseph Mucumbitsi, Liliane Muhimpundu, Gratien Twagirumukiza, Martin Ndayambaje, Hiberte Migabo, Lydia Mwanzia
Introduction: Asymptomatic bacteriuria (ASB) is a global health concern during pregnancy. It accounts for 2%–15% of pregnant women globally. This study was carried out to determine the prevalence of ASB, the leading cause of ASB during pregnancy, and the antibiotic susceptibility pattern of bacteria associated with ASB. Materials and Methods: This was a cross-sectional study conducted from September to December 2021 at Muhoza Health Centre. About 142 pregnant women without symptoms of urinary tract infections were recruited. The urine sample collected was put in a sterile Stuart plastic container and transported to INES Ruhengeri clinical microbiology for bacterial identification. The structured interview was conducted to assess factors associated with ASB among women. Logistic regression analysis was performed to test the relationship between demographic characteristics and ASB, while a Chi-square test (x2) was performed to test for association with ASB and other determinants considered in this study. Results: About 70.40% of participants had ASB. Pregnant women in the second trimester (28.16%) and first trimester (25.35%) were the most affected, while women aged 24–29 (28.16%) were the most affected. Escherichia coli (27.6%) and Klebsiella pneumonia (23.8%) were the predominant isolated bacteria in the urine and was observed to be the most coloniser of the urinary tract throughout all the pregnancy trimesters. Among demographic characteristics, urban residence (P = 0.005, 95% confidence interval [CI]: 0.717–4.160), primary education (P < 0.00001, 95% CI = 15.390–19.310), ordinary education (P < 0.00001, 95% CI = 16.550–20.455) and advanced level education (P < 0.00001, 95% CI = 17.194–20.650) were statistically significant to contribute to ASB. Hygiene (x2 = 6.81, P = 0.009) was significantly associated with ASB. K. pneumonia and Staphylococcus saprophyticus were the most resistant bacteria to selected antibiotics. Conclusion: ASB may be an epidemic in pregnancy. Early diagnosis of ASB is recommended in early pregnancy to prevent pregnancy-associated complications.
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A head-to-head randomised controlled trial of aripiprazole versus quetiapine as augmenting agents in treatment-resistant depression p. 307
Alok V Kulkarni
Introduction: Almost 30%–50% of the patients with major depressive disorder can be categorised as treatment-resistant depression (TRD). The use of augmenting agents such as aripiprazole (ARI) and quetiapine (QP) to the existing antidepressant (AD) therapy could be a suitable alternative for treating TRD. The superiority of anyone over others is not established in short-term studies. Hence, the present study was performed to compare the safety and efficacy of ARI and QP for the treatment of TRD. Materials and Methods: In the present study, a total of 50 patients with TRD who showed insufficient response to at least two ADs for 12 weeks were enrolled. The participants were assigned randomly in a double-blind trial to receive ARI (10 mg/day; n = 25) or QP (300 mg/day; n = 25) in addition to their standard AD therapy for 12 weeks. Montgomery–Åsberg Depression Rating Scale (MADRS) and the Clinical Global Impressions (CGI) scale were used to measure treatment efficacy. The safety was evaluated by recording treatment-caused adverse effects (AEF). Results: A significant decrease in MADRS score was observed with ARI groups than in the QP group (‒7.5; ‒4.6, P < 0.001). The CGI scores in the ARI group also exhibit significant improvement compared with the QP group. There was a non-significant change in CGI score recorded in both groups. The AEF was observed in 11% of patients with more incidences in the QP groups. The incidences of AEFs resulting in discontinuation of therapy were found low in both groups (ARI: 1.6%; QP: 3.2%). Conclusion: The findings of this study conclude that TRD patients can be more benefitted by ARI augmentation therapy than QP.
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Comparison of haemoglobin estimation of blood donors by specific gravity method, HemoCue method and automated haematology cell analyzer p. 312
Nikhil Choudhari, Subhashish Das, Ravi Kumar
Introduction: Pre-donation haemoglobin (Hb) screening is among the foremost test done on blood donors to determine whether an individual is fit to donate with the intention of preventing inadvertent donation from an anaemic donor. The aim of the study was to compare the efficacy of the three common Hb estimation methods, namely, copper sulphate (CuSO4) method, HemoCue photometer and automated cell counter in reporting the Hb levels of blood donors. Materials and Methods: CuSo4 specific gravity method, HemoCue and automated cell analyzer (Sysmex XN-550) were used to determine the Hb levels in blood samples of 500 donors. Descriptive statistics were used to analyse the demographic details of the donor. Kappa statistics were used to determine the level of agreement between the three methods of Hb estimation. Results: HemoCue was found to be more sensitive (86.21%), whereas CuSo4 (97.88%) was found to be more specific. Kappa agreement was good between CuSo4 and Sysmex XN-550 (0.703), whereas it was moderate between HemoCue and Sysmex XN-550 (0.458). Conclusions: The CuSO4 method is still viable for Hb estimation among blood donors. Thus, it can be utilised as the primary screening method; however, follow-up testing with HemoCue or automated cell analyzer can be done to minimise unnecessary deferrals and false acceptance.
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Correlation of gender and anthropometric measurement with pulmonary function tests among undergraduate medical students p. 316
Iffat Jahan, Momtaz Begum, Sharmin Akter Sumi, Nusrat Jahan, Md Zakirul Islam, Mainul Haque
Introduction: This study aimed to evaluate the effect of gender and anthropometric measurement on pulmonary functions (forced vital capacity [FVC], forced expiratory volume in 1st s [FEV1] and peak expiratory flow rate [PEFR]) of undergraduate medical students to emphasise the need for further research on the aetiology and the prevention of respiratory diseases. Materials and Methods: This cross-sectional study was conducted in the Department of Physiology, Chittagong Medical College (CMC), Chattogram, Bangladesh, from July 2017 to June 2018. A total of 100 participants, aged between 18 and 20 years, studying in the 1st year in CMC, were included by a random sampling method. The participants filled out a questionnaire with general information about previous diseases, medication and family history. Fifty male participants were enrolled in the study group according to inclusion and exclusion criteria. Age and body mass index matched another 50 female participants were included. Respiratory parameters such as FVC, FEV1 and PEFR were measured by a digital spirometer (Chestgraph HI-101, Japan). Readings were taken in normal upright sitting posture. The statistical tests utilised were unpaired Student's t-test and the correlation coefficient conducted using SPSS for windows version 23. Results: Female participants showed significantly lower FVC, FEV1 and PEFR than males. This study observed a significant positive correlation between height and weight and FVC, FEV1 and PEFR. Conclusion: The results of this study help assess pulmonary functions among medical students as pulmonary function tests are one of the indicators of the health status of the individuals.
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Zirconia monolithic veneers: A durable and cosmetic alternative to regular veneers? p. 322
Rajesh Shetty, Siddharth Shrirang Pinge, Sanath Shetty, Parmeet Banga, Mohammed Zahid
Ceramics have greatly evolved since they came into the eye of the dental community. Currently, there is a demand for a highly aesthetic as well as strong restoration and high translucent zirconia fits that criteria pretty well. This has significantly increased the applicability of zirconia as a restorative material in aesthetically demanding cases. Veneers have an innate disadvantage of lack of strength, decreased fracture resistance and chipping. Using these highly translucent zirconia veneers will help overcome these disadvantages. Therefore, the objective of the case series was to test the effectiveness of adhesively bonded highly translucent zirconia veneers using resin cement. This type of veneers provides satisfactory aesthetic outcomes and decreases the risk of fracturing during the trial and clinical use. However, further studies with long-term follow-ups are needed.
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Nasolabial cyst in an unusual location within the upper lip – A rare case report p. 326
Sushruth Nayak, Prachi Nayak, Kush Pathak, Surbhi Singh, Asha Karadwal
The nasolabial cyst is a rare non-odontogenic cyst that develops between the upper lip and nasal vestibule. It has unsure pathogenesis. It has a history of slow-growing lesions, and clinically on palpation gives a floating touch. Usually, there is an elevation of the upper lip. The swelling usually, in most cases, is asymptomatic produces a localised swelling along with varying degrees of nasal obstruction. We present a case of a nasolabial cyst which was clinically diagnosed as a lipoma because of its unusual location in the upper lip in a 46-year-old man, which slowly increased in size over a period of 6 months with the association of slight pain on palpation and facial disfigurement. Our objective is to alert the dental professionals about the unusual presentation of nasolabial cyst in the upper lip, which may become a hurdle in clinical diagnosis.
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The use of α1-adrenergic receptor antagonists in the prevention of adverse outcomes of COVID-19 infection in obese patients p. 329
Auda Fares, Resul Toprak, Dieter Borrman, Julius R Ivester
Obesity is widely reported to be associated with a higher risk of the severity and worse clinical outcome of COVID-19. With the global prevalence of obesity, exploring the relationship between obesity and the severity of COVID-19 disease is of major clinical importance, thus requiring increased attention to preventive measures in susceptible individuals. Studies have shown that obesity is associated with increased risk of hospitalisation, intensive care unit admission, integrated motivational–volitional requirement and mortality among patients with COVID-19. The pathophysiological mechanisms which cause disease severity and adverse outcomes among obese subjects remain unclear. Recently, it was shown that elevated leptin levels correlate positively with the severity and progression of disease in COVID-19 patients. Leptin modulates both the innate and adaptive immune responses in cells. Elevated leptin levels in obese individuals may contribute to worse symptoms and outcomes in COVID-19 disease. Emerging evidence suggests that alpha-1 (α1)-adrenergic receptor stimulation increases leptin secretion, while the administration of α1-adrenergic receptor antagonists is reported to reduce plasma leptin levels in human subjects. Therefore, α1-adrenergic receptor antagonists may improve clinical outcomes in obesity patients with COVID-19 infection through modulation of hyperinflammation and reduction of plasma leptin levels. The aim of this minireview is to delineate the potential beneficial therapeutic effects of α1-adrenergic receptor antagonists in preventing adverse outcomes of coronavirus infection in obese patients. Large, randomised trials are needed to confirm the beneficial effects and safety profile of the use of α1-adrenergic receptor antagonists in obese patients with COVID-19.
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