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   Table of Contents - Current issue
May-August 2022
Volume 12 | Issue 2
Page Nos. 87-214

Online since Friday, May 13, 2022

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The global impact of the COVID-19 pandemic on the education of healthcare professionals, especially in low- and middle-income countries Highly accessed article p. 87
Kona Chowdhury, Mainul Haque, Ayukafangha Etando, Santosh Kumar, Halyna Lugova, Moyad Shahwan, Ranko Škrbic, Ammar Abdulrahman Jairoun, Brian Godman
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Growing concern over rising caesarean section rates: Is it a problem for low- and middle-income countries only? Highly accessed article p. 93
Badar Uddin Umar, Mainul Haque
The rising caesarean delivery rate is a global concern and is believed by many as a problem in low-income countries exclusively. It has been observed that utilisation of this lifesaving procedure is unusually high in many middle- and high-income countries. Caesarean section (CS) is indicated to save both the mother's and child's life in certain situations. When chosen in the proper indication, it is helpful towards reducing morbidity and mortality in both. There is a vast number of papers evidencing the injudicious use of this necessary procedure. There is an evident disparity in the utilisation of the process too. In some sub-Saharan African countries, women do not have access to or have very minimal access to caesarean delivery due to many factors. On the other hand, certain countries overutilise it. Being a South Asian country, Bangladesh is no different from many other countries, with rising caesarean delivery rates in rural and urban populations. It is of great concern for the Bangladeshi general community and the healthcare workers. There have been claims that it is overutilised injudiciously by the Bangladeshi health force. This review aims to find the facts related to the CSs and compare between the high-, middle- and low-income countries. Being healthcare professionals and medical educators by origin, the authors were explicitly interested in Bangladesh. They conducted the review to contribute to the development of the country's healthcare system.
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Student-centred approach in medical education: A review of the teaching-learning activities and the perceptions of educators on the students engagement and performance at the faculty of medicine and defence health, national defence university of Malaysia Highly accessed article p. 101
Yasmin Anum Mohd Yusof, Nursiati Mohamad Taridi, Marami Mustapa, Shazreen Shaharuddin, Mohammad Wisman Abdul Hamid, Nik Noorul Shakira Mohamed Shakrin, Frhana Rahmat, Nur Aishah Che Roos, Nur Adnin Ahmad Zaidi, Halyna Lugova
The knowledge and the beliefs on medical education influence the teaching-learning approach used by medical educators and their perception of students' ability to be active learners. This paper highlights the student-centred teaching methods used by the medical educators of the Faculty of Medicine and Defence Health, National Defence University of Malaysia for undergraduate medical student teaching, their medical education approach in teaching and their perception on students' performance.
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Epidemiological study of brain cancer in Iran: A systematic review p. 108
Fatemeh Hadavand-Siri, Soheil Hassanipour, Hamid Salehiniya
Introduction: In recent decades, the incidence and mortality rate of brain tumours, especially in adults, has increased. In order to better plan to reduce the burden of this cancer, knowledge of the epidemiological aspects of this disease is essential. Therefore, due to the lack of a comprehensive study on brain cancer in Iran, this study aimed to investigate the epidemiological aspects of this cancer in Iran. Methods: In June 2020, keywords of 'brain tumour', 'nervous system tumours', 'nervous system neoplasm', 'nervous system cancer', 'central nervous system (CNS)' and 'Iran' were searched on Medline/PubMed and Web of Science databases Scopus, Embase, SID, IranMedex, and Google Scholar. The search results were entered Endnotes Version 8; finally, 35 full papers were reviewed and included in the study. Results: The incidence of brain cancer and CNS tumour is lower in children in central Iran. The incidence of CNS cancer was relatively high among children in Golestan province. Furthermore, the standardised incidence of primary CNS tumours in Iran is 5.69 per 100,000, which is lower than in other countries. Nervous system malignancies were more common in men than in women (age-standardized rate 3 versus 2.2 per 100,000 in men and women, respectively). Tehran had the highest incidence of CNS tumours. Meningiomas were the only most common tumour in women. Gliomas were the most common primary brain tumour, and most of the lesions in this subgroup were in low-grade astrocytoma and ependymomas. Brain cancer mortality was higher in men than in women. Age is a potential risk factor, and the incidence of CNS tumours increases with increasing age after 30 years. Conclusion: Nervous system cancers are on the rise in Iran due to lifestyle changes and increased risk factors. Planning to reduce risk factors and early detection of the disease can be helpful in reducing cases and reducing mortality.
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The role of severe acute respiratory syndrome coronavirus 2 viroporins in inflammation p. 114
Arghavan Zebardast, Tayebeh Latifi, Jila Yavarian
In December 2019, genomic screening of clinical samples from patients with viral pneumonia in Wuhan, China, revealed the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 is the official name for the disease caused by this virus, according to the World Health Organization. SARS-CoV-2 can activate the NLRP3 inflammasome directly in apoptosis-associated speck-like protein (ASC)-dependent or independent manner through several proteins, including viroporins. Viroporins are viral proteins with ion channel functions that play crucial roles in different aspects of virus replication and pathogenesis. SARS-CoV-2 viroporins encoded by Open Reading Frame (ORF) 3a, ORF8 and the E gene activate the NLRP3 inflammasome and trigger the cleavages of pro-interleukin 1 β (IL1 β) and pro-IL18 by the caspase enzyme and convert them to the mature form (IL-1 β, IL18). Most of the inflammation in severe COVID-19 patients is caused by the activation of inflammasomes. Studies revealed that SARS-CoV-2 viroporins could be the possible targets for therapeutic interventions.
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Recent advances in direct reinforced restorations for vital teeth p. 120
Karan Bhargava, Chaitra Mastud, Santosh Kumar Mastud, Deepak M Vikhe, Pooja Newase, Prasad Nanasaheb Mhaske
The conservative option depends mainly on the ability of the bonded restoration to strengthen the enamel in the same way that dentine gives strength and supports the enamel. In order for a dental material to reinforce the vital tooth, it must bond to dentine. As such, an essential attribute of a good dentine adhesive system is the ability of the adhesive to wet and infiltrate the dentine. In restorative dentistry, numerous studies have demonstrated coronal reinforcement of the vital tooth through bonded restorations. Six bonded amalgams and resin composites have all been shown to reinforce the remaining vital tooth structure by bonding to dentine and enamel.
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Healthcare-associated infections in the surgical setting: How to prevent and treat them p. 127
Massimo Sartelli
Healthcare-associated infections (HAIs) are infections that patients can get while receiving medical care. These infections are often preventable and represent one of the most common adverse events in health care. Patients with medical devices (central lines, urinary catheters and ventilators) or who undergo surgical procedures are at risk of acquiring HAIs. The most common HAIs are surgical site infections, urinary tract infections, pneumonia, bloodstream infections and Clostridioides difficile infections. This review takes into consideration the aspects of both prevention and treatment of the most common HAIs and the aspects related to a possible behavior change among health-care workers in the surgical setting.
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The combined occluding effect of sodium fluoride varnish and erbium: Yttrium-aluminium-garnet laser irradiation on dentinal tubules − CLSM and SEM study p. 138
Sahil Kawle, Harshraj Gawande, Jaiti Gupte, Apurva Jadhav, Swati Raut, Sonal Sinha
Introduction: Dentin hypersensitivity (DH) is one of the most common problems, but to date, no single agent or form of treatment has been found effective. Lasers have promising potential for the treatment of DH. This in vitro study aims to compare and evaluate the desensitising ability of a combination of sodium fluoride varnish (NaF) and Erbium: yttrium-aluminium-garnet (Er: YAG) laser by assessing tubule occlusion and depth of penetration of the agent in dentinal tubules through Scanning electron microscope (SEM) and Confocal laser scanning microscope (CLSM), respectively. Materials and Methods: Forty-five extracted maxillary premolar teeth were included in this study. A 3-mm-thick horizontal slice was prepared from the cementoenamel junction of each tooth. Each slice was transversely separated into two halves as buccal and lingual samples. Ninety samples were obtained, and these samples were randomly divided into six equal groups. Groups A, B, C, and D were used for the evaluation of tubule occlusion with SEM Groups E and F were evaluated for dentin permeability with CLSM. Results: Intergroup comparisons showed statistically significant differences among groups, and it was observed that the combined use of Sodium fluoride and Er: YAG Laser showed better occluding (Group D) and depth penetration (Group F) effect when analysed using SEM and CLSM, respectively. Conclusion: It can be concluded that a combination of fluoride varnish and lasers offers a significant role in dentinal hypersensitivity.
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Eustachian tube dysfunctions due to mask among quarantined health-care professionals during COVID-19 pandemic p. 144
Rohit Kumar Phulsunga, Sunil Kumar, Avinash Surana, Vikas Gupta
Introduction: The most effective preventive measures against COVID-19 among health-care personnel (HCP) are personal protective equipment (PPE) and hand hygiene. The documented side effects of continuous use of mask or PPE are dermatitis, but side effects on the Eustachian tube are untouched areas. The aim of this study was to investigate the Eustachian tube dysfunctions among HCP due to the continuous use of masks. Materials and Methods: This web-based cross-sectional study was conducted among 217 eligible HCP. The sample size was calculated as 97, considering the unknown prevalence of Eustachian tube dysfunctions among HCP (50%), so all HCP were included in the study. A structured questionnaire with close-ended responses was developed to collect study participants' responses. Results: Out of 217 participants, only 207 participants provided their written consent after understanding the study objectives and 206 were included in the analysis as one subject has pre-existing ear disease. The daily hours of mask usage among 52.4% of participants were between 4 and 8 h. About 2.6% of doctors experienced severe pain and pressure in the ear. Eustachian Tube Dysfunction Patient Questionnaire-7 score was significantly higher among females and masked usage of four or more hours (P < 0.05). Conclusion: The present study revealed that 42.3% of participants had Eustachian tube dysfunctions. The study findings might help local administration to provide practical recommendations for medical workers prior head supported masks instead of ear-supported masks, use of ear protectors.
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Comparative evaluation of the physical properties of membranes for periodontal regeneration: An In vitro Study p. 151
Apoorva Mhatre, Devanand Shetty, Arvind Shetty, Suyog Dharmadhikari, Pooja Wadkar
Introduction: Barrier membranes are the devices used in guided tissue regeneration procedures to promote the repopulation of the wound space by periodontal ligament cells. Commercially available membranes have been used widely for periodontal regeneration. The aim of the present study is to compare and evaluate the physical properties of membranes used for periodontal regeneration. Materials and Methods: The tensile strength and surface topography using scanning electron microscope were analysed of three commercially available membranes: chorion membrane, Healiguide membrane and PerioCol®-GTR membrane were analysed. Results: The tensile strength of the PerioCol®-GTR membrane was the highest, while that of the Chorion membrane was the least. Variations in the surface topography were observed in all three membranes groups. Conclusion: The study demonstrated variation in surface topography and tensile strength of the resorbable periodontal membranes, suggestive of differences in the time of resorption during regenerative periodontal procedures.
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Evaluation of the knowledge and level of information about stem cells research and therapeutic potential among medical and dental postgraduate students of sumandeep vidyapeeth, Vadodara p. 159
Ankit Sant, Deepak Dave, Monali Shah, Neeraj Deshpande, Jasuma Rai, Prasad Nadig
Introduction: Stem cells are definite units competent of both self-renewal and differentiation into numerous cells. Embryonic and postnatal tissues are the major sources of stem cells. The aim of the study was to assess the knowledge and level of information about stem cells research and therapeutic potential among Medical and Dental postgraduate students of Sumandeep Vidyapeeth, Vadodara. Materials and Methods: The Medical and Dental postgraduate students of Sumandeep Vidyapeeth, Vadodara, were selected. The questionnaire form was taken to them by the principal investigator personally and explained about the study and asked to fill the questionnaire after obtaining consent. The collected questionnaire was excluded if more than 30% of questions were not filled. Results: A total of 435 medical and dental postgraduate students of Sumandeep Vidyapeeth, Vadodara, were included in the study. 109 dental postgraduates (26.58%), and 301 were medical postgraduates. All participants had a basic knowledge of stem cells (100%), but only a few had specific knowledge (3.90%). Only a few agreed to human embryo research and considered it ethical (0.73%). All agreed to conserve their child's umbilical cord for the child's therapeutic purposes. Conclusion: We can conclude that the knowledge and level of information about stem cells exhibited by most of the participants were minimal. However, all participants expressed a genuine desire to enhance their knowledge regarding stem cells. There is a need for Continuing Medical Education/ Continuing Dental Education (CME/CDE) workshops as well as conferences on this subject to upgrade the knowledge of participants and the community as a whole.
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Comparative evaluation of quality parameters of platelet stored in additive solution versus plasma p. 163
Subhashish Das, ML Harendra Kumar
Introduction: Extension of the shelf life of platelets remains a challenge for transfusion services, and efforts techniques are required to extend the shelf life of platelets beyond 5 days without compromising their qualities. Materials and Methods: The study is being done to compare in vitro changes of platelet indices-platelet count, mean platelet volume, platelet distribution width (PDW), pH and swirling in stored platelet concentrate (PC) with and without platelet additive solution (PAS) for 0,3,5,7 and 10 days. Results: Serial measurements of various parameters in PCs with and without PAS showed that PCs stored in PAS were better maintained and had optimal quality standards throughout the extended storage time as compared to the PCs without PAS. The results obtained in both categories were statistically significant (P < 0.001). Conclusion: Our study showed that the use of PAS in the PCs increased the shelf life and improved the viability of platelets as compared to the PCs without PAS.
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Patient satisfaction over changing dental treatment trends during COVID-19 pandemic-a cross-sectional study p. 168
Aalap Sureshkumar Prajapati, Pinal Kirankumar Solanki, Vasudha Sodani, Harsh Shah, Kavish Gurjar, Ruchi Patel
Introduction: Patient satisfaction in health care describes the degree to which patients' needs 'meet their expectations and provide an acceptable standard of care'. Therefore, their opinion should be incorporated to understand factors affecting patients' satisfaction with the health-care setting. The recent COVID-19 pandemic has posed a significant challenge for the field of dentistry owing to its working characteristics. It is difficult for dentists to provide optimum satisfaction to patients receiving dental care with such changes proposed. A study aiming to evaluate the patient's satisfaction receiving treatment in the Department of Dentistry during the pandemic was planned. Materials and Methods: A cross-sectional observational study from September to November 2020 was conducted. A self-administered printed questionnaire drafted in English/Gujarati was provided to 225 patients on completion of their dental treatment. Thirteen close-ended questions were included in determining the patient's satisfaction. Descriptive statistical analysis was used to describe the parameters of the questionnaire. The Chi-square test was used to find a significant association between parameters, and P < 0.05 was considered statistically significant. Results: About 74.3% of the participants were satisfied with dentist–patient communication. Positive response (80%) by patients where they were able to get an appointment as per their suitability and were informed in advance by the department if there were any changes. One hundred and sixty-eight (84%) patients responded that the waiting area was hygienic. One hundred and thirty-seven (68.5%) patients assured that their arrival was intimated to the respective dentist by supporting staff and that they were taken into an operatory for treatment within 10 min of arrival. Participants said that they were informed about the delay from their allotted appointment schedule with reasons; hence, better compliance (79%) was obtained from them. Conclusions: This cross-sectional study indicated that with proper communication, a positive response by participants over satisfaction was obtained even due to changing treatment patterns due to pandemic.
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Awareness, Knowledge and Attitude of Teledentistry Among Dentists in Kanchipuram District – A Cross-Sectional Survey p. 174
R Kamalakannan, C Nagappan, M Krishnaveni, NC Arun Prasad, S Vinoth Kumar, J Mahesh
Introduction: A highly infectious and life-threatening novel coronavirus Corona Virus Disease (COVID-19) has been spreading worldwide, causing severe medical complications and practising dentistry is becoming difficult. To reduce the risk of spread of coronavirus infection between dentist and patient, teledentistry, an innovative digital tool, has the potential to reach patients straightforward without direct contact. Materials and Methods: A self-structured standard questionnaire was framed and distributed among dentists from July 2021 to August 2021. The survey consisted of 15 closed-ended and multiple-choice questions related to awareness, knowledge and attitude of teledentistry during this COVID 19 pandemic. After proper validation of the questionnaire from the experts and evaluating reliability, the survey was conducted by forwarding the link of the Google Form through social media. Totally 520 participants responded to the survey. The statistical analysis was performed using SPSS statistical software version 21. All statistical analyses were carried out at a significance level of P < 0.05. The descriptive data were analysed and compared using the Chi-square test. Results: Among specialists, general practitioners, postgraduate students and undergraduate students, specialists have better awareness, knowledge and attitude of teledentistry. Almost all participants have 50% knowledge about teledentistry and have a high (80%) attitude towards teledentistry. Conclusion: From this study, it is clearly understood that it is high time to increase the use of teledentistry practice by spreading knowledge among dentists and dental students. It is potentially an innovative digital tool in this new era of dentistry. It is an effective tool not only in the current pandemic situation but also in emergencies. Thus, teledentistry is a satisfied boon in the field of dentistry through the use of digital technology.
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A pilot study regarding the consequences of the COVID-19 pandemic on healthcare education in India and the implications p. 180
Paras Sharma, Kona Chowdhury, Santosh Kumar, Rohan Bhatt, Tanvi Hirani, Shilpa Duseja, Mainul Haque, Afzalunnessa Binte Lutfor, Ayukafangha Etando, Ranko Škrbić, Moyad Shahwan, Ammar Abdulrahman Jairoun, Brian Godman
Introduction: The early approaches to prevent the spread of COVID-19 included lockdown and social distancing measures, leading to university closures. These measures forced unparalleled changes to the delivery of healthcare education. Concerns included the preparedness of faculty and students to e-learning as well as the routine availability and funding of equipment and internet bundles. This needed addressing with fully trained healthcare professionals required given rising inappropriate use of antibiotics in India, growing prevalence of non-communicable diseases as well as an increasing number of patients with joint comorbidities. Consequently, there is a need to ascertain the current impact of the pandemic on healthcare student education across India. Materials and Methods: This was a pilot study among 10 purposely selected healthcare educators in both private and public universities. The questionnaire built on published studies. Results: Identified challenges included a lack of familiarity with online education, no bedside teaching, lack of equipment and affordability of internet bundles, poor internet connectivity and postponed examinations. Ways forward included training faculty on e-learning, providing students with loans and other financial support to purchase equipment and internet bundles, establishing COVID-19 prevention protocols and protective equipment, recording lectures and tutorials to make up for lost time and simulated methods to teach clinical aspects. Conclusion: Despite challenges, there was a rapid move to online learning among surveyed universities. Alongside this, courses to address lack of familiarity with e-learning approaches with hybrid teaching approaches here to stay. The next step will be to undertake a wider study and to use the combined findings to provide future guidance.
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Knowledge, attitude and practices related to tuberculosis among students in a public university in East Coast Malaysia p. 190
Mira Nadiah Mohd Izham, Nor Azlina A Rahman, Mainul Haque
Background: Tuberculosis (TB), better known as TB, is one of the infectious diseases that can cause death and therefore gains major public concerns worldwide. This study attempts to assess the knowledge, attitude and practice (KAP) related to TB among the students in a public university and find the association between the KAP with demographic factors and between the KAP themselves. Materials and Methods: Self-administered questionnaires were distributed to 200 students from the six faculties in the university for the data collection and analysis in this cross-sectional study. The questionnaire was divided into four parts: Demographic characteristics, knowledge, and attitude toward TB, and practices toward the prevention and control of TB. Results: The findings showed that most students had a moderate level of knowledge (obtained 47–92 out of the total 138 marks) and practice (obtained 29–57 out of the total 86 marks) and a good attitude related to TB (obtained 20–28 out of the total 28 marks). There were no significant differences in the level of KAP scores between the different genders, ages and years of study among the participants. However, a significant result was found between the KAP level of the various faculties (P < 0.001, <0.001 and 0.027, respectively), with the students from the Faculty of Medicine having the highest KAP level compared to others. Conclusion: This study also portrayed that higher knowledge was associated with a higher attitude and practice towards TB (P < 0.001 and 0.045, respectively). Based on the findings, the study proposes more health education programs to promote the awareness on early prevention of TB to achieve an improved level of KAP in controlling and preventing TB infection.
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Burden experience by cancer patient caregivers: A cross-sectional study p. 198
Shreenath Kulkarni, Niraj Pandit
Introduction: Cancer is one of the leading causes of death all over the world, estimated by various organisations. It affects the life of the patients as well as their caregivers. Caregivers feel the burden with respect to various factors while caring for a cancer relative. Materials and Methods: A cross-sectional study was conducted during October–November 2020 at the selected hospitals of Bareilly, UP. A total of 34 caregivers were selected for the study with non-probability purposive sampling who were involved in the direct care of cancer patients. Baseline pro forma and family burden assessment tools were used for the data collection. Results: It was found that the majority of the caregiver (58.8%) experience mild-to-moderate burden while caring for the cancer patient. Conclusion: The caregiver of a cancer patient feels the burden. There could be various factors such as financial burden and stressors, along with the health issue of a loved one that could result in caregiver burden.
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An epidemiological study of elongation of styloid process in the saurashtra population: A retrospective radiographic digital orthopantomographic study p. 202
Reeta Jha, Mansi Khatri, Foziya Pathan, Mansi Solanki, Hiren Tandel
Introduction: The styloid process (SP) is a cylindrical bony structure emerging from the lower surface of the petrous temporal bone, its normal length is from 20 mm to 30 mm and those with more than 30 mm length are considered elongated. Calcification in stylohyoid ligament or calcification of SP is termed Eagle's syndrome. The aim of this study is to conduct an epidemiological survey of SP on digital orthopantomogram (OPG) in the Saurashtra population with an age range of 5–90 years. Materials and Methods: This is a retrospective study of 1088 OPG radiographs randomly selected from the database of 2019–2020 from the oral medicine and radiology department of our institute, which was taken on the OPG model CS 8100 Carestream digital panoramic system. Measurements of SP were done from the temporal bone to the tip. Those with more than 30 mm in length were considered to be elongated. The study sample was divided into four different age groups and was compared according to gender and sides. The Chi-square test and t-test were performed. Results: Elongated SP was noted in 354 (32.53%) out of 1088 subjects. Among age groups, subjects of more than 50 years showed a maximum number of elongated SPs. Conclusion: Subjects showing elongated SP and their mean length are increased with age, which indicates chronic development of calcification. No statistical significance was found in the elongation of SP in correlation with the cohort's gender and sides (bilateral or unilateral).
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Obesity is the alleyway to insulin resistance and Type 2 diabetes mellitus p. 207
Susmita Sinha, Mainul Haque
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Current status of disorders of sexual development in Indonesia p. 210
Ziske Maritska, Erlangga Danu Saputro, Randy Pangestu, Extin Faulinza, Marda Sakinah, Fenny Pranandita, Flavia Angelina Satopoh, Ivani Ridwan, Sarah Amalia
Disorders of Sex Development (DSD) rise challenges in various aspects of life due to the abnormalities in the patients' sex chromosomes, gonads or reproductive organs. Its causes are often due to genetic and environmental factors. Considering the complexity of the condition, the patients require comprehensive management and an interdisciplinary approach. The delayed intervention may reduce the quality of life in patients, implying the significance of early detection and diagnosis. There is only little data present on the incidence and characteristics regarding DSD patients in Indonesia. This review wished to provide insight into the current status of DSD in Indonesia.
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Retraction: Impacts of low-protein diet on the hippocampal CA1 neurons and learning deficits in rats p. 214

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