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   Table of Contents - Current issue
January-June 2022
Volume 9 | Issue 1
Page Nos. 1-84

Online since Monday, June 27, 2022

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Gender-Wise histological differences in the human upper lip Highly accessed article p. 1
Swati Saxena, Arvind Kumar Pankaj, Sachin Panwar, Anita Rani, Jyoti Chopra, Archana Rani
Introduction: Knowledge of morphometry of lip lining help in deciding the best site for choosing graft for its better uptake during several dermal grafting procedures following craniofacial cancers or cosmetic procedures. It also proves useful in dermatopharmacokinetics, in which we monitor the effect of drugs acting on connective tissue by translabial route and lip augmentation surgeries (esthetic surgery) where care is to be given for dermal fillers not to be injected into the muscle core of lip. Materials and Methods: Ten human male cadavers and 10 human female cadavers were procured. The rectangle-shaped skin specimen (1 cm × 1 cm) through the upper lip was stained with hematoxylin and eosin stain. A total of 40 slides were prepared. Readings were obtained with the help of CATCAM E series HD cameras which was installed in light microscope. Results: The mean value of thickness of skin (epidermis + dermis) of the lip was 664.72 μm among males while 769.20 μm among females. Conclusion: The epithelium of females is marginally thicker than males. Edp: sc (epidermis/stratum corneum) ratio can suggest that giving drugs through translabial route will be easy in females as compared to males in the upper lip as the stratum corneum is the main barrier in drug transfusion and its absorption secondary to epidermis as a whole. The number of rete pegs per field at the dermoepidermal junction was higher in males which ensures more stability of skin of male lips compared to females.
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Brain and COVID: A case series of neurovascular complications p. 6
Rajagopal Srinath, Subrat Kumar Nanda, Vikram Asturkar, FMH Ahmad, Vinny Wilson, Uday Yanamandra, Anil Menon
Introduction: COVID-19 is caused due to infection with severe acute respiratory syndrome-coronavirus-2. A change in the epidemiological pattern of neurovascular diseases has been observed among patients who have had COVID-19 infection. There are not enough studies which have evaluated the neurovascular manifestations among patients of COVID-19 infection. Materials and Methods: This single-center observational study was intended to evaluate the correlation between various COVID-19-related parameters with the outcomes of vascular events among patients of COVID-19 who developed neurovascular complications. The study was conducted at a tertiary hospital in Pune, India, from February 01, 2021, to October 10, 2021. The study population involved patients with COVID-19 of varying severity and associated neurovascular complications. The total number of patients was 22 in number. The deidentified data were analyzed using JMP version 10.040. Results: Among a total of 22 patients, 16 (73%) had arterial infarcts, 5 (23%) had venous infarcts, whereas 1 (4%) had intracerebral hemorrhage. Four (18%) patients had features of severe COVID-19 and 2 (9%) of them had a modified Rankin Scale of six. There was a strong correlation between the severity of COVID infection and the severity of neurovascular complications. A positive correlation was observed between the time duration from Reverse transcriptase polymerase chain reaction (RT-PCR) positivity to neurovascular complications with the duration of >45 days having a poorer outcome. Conclusion: COVID-19 is more likely to cause thrombotic vascular events including stroke. The severity of COVID-19 is directly correlated with poorer outcomes. The duration between RT-PCR positivity and neurovascular symptoms if >45 days, has a poorer outcome.
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Evaluation of the efficacy of tranexamic acid in control of bleeding in total knee replacement: An interventional comparative study p. 10
Goutam Kumar Satpathy, Sabyasachi Swain, LV Gouri, Debi Prasad Nanda
Introduction: Among the various strategies for in routine total knee replacement (TKR), tranexamic acid (TA) has always been a safer and affordable method. Surgeons have used it in intravenous, intraarticular or in a combined manner to reduce blood loss because it is easily available and has an easy dosing regimen. We aim to find out its efficacy and associated complication when used intravenously. Materials and Methods: This study was done in our institute among 27 cases who was operated for primary TKR. They were distributed into two groups based on the use of TA. Hemodynamic parameters such as blood loss, reduction in hemoglobin (Hb), and blood transfusion were assessed. Student's t-test and ANOVA were utilized for tests of significance. Results: Out of 27 patients, 17 (62.9%) were female and in the age group of 51–60 years. Most 22 (81.5%) had osteoarthritis. The difference in blood loss across various pathologies and comorbidities was statistically insignificant. Average blood loss was 266.2 ml ± 64 ml (Range = 150–406 ml) per TKR in the 1st group. In 2nd, it was 667.5 ± 111.5 ml (Range = 414–860 ml) (P < 0.001). Mean Hb loss was 0.78 ± 0.275 g/dl (Range = 0.1–1.2 g/dl) in Group A. It was statistically significant comparing to Group B where it was 1.86 ± 0.55 g/dl (Range = 1.5–3.7 g/dl). Tourniquet used though decreased blood loss, it was not statistically significant. Conclusion: TA used in intravenously is very effective in decreasing the loss of blood and transfusion requirements in patients of primary TKR.
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Ki-67 expression in oral potential malignant and malignant lesions and correlation of mitotic index with MIB-1 labeling index p. 14
Ankita Mittal, Seema Awasthi, Rashmi Chauhan, Faiyaz Ahmad, Ashutosh Kumar, Nishant Mitra
Introduction: Oral cancers are the most serious health issues in underdeveloped countries such as India and considered as the main cause of death. Among them, oral squamous cell carcinoma is the most common type (90%) of all malignancies. Various oral potential malignant lesions (OPMLs) can transform into malignancies. This study was conducted to determine the significance of Ki-67 expression in oral potential malignant and malignant lesions (MLs) as well as correlation of mitotic index (MI) with MIB-1 labeling index (LI) in these lesions. Materials and Methods: The study was performed on 60 cases in a tertiary care center over a period of 2 years. Ki-67 expression, MI and MIB-1 LI were calculated and correlated. Results: In the studied population, there were 49 (81.7%) males and 11 (18.3%) females. The mean age was 46.60 ± 9.94 (23–68 years), with majority of patients in 41–60 years of age group (46/60 cases). Anterior 2/3rd tongue is the most affected site, presented ulcer as the most common lesion. Smoking, tobacco, and betel nutchewing addiction were presented in 72% of the patients. Among 60 cases, 45 (75%) were OPMLs, while 15 (25%) cases were MLs. MI increases in OPMLs and MLs and comparison was significant (P < 0.01). MIB-1 LI was significant (P < 0.01) on comparison to dysplasia III and MLs. A positive correlation (0.01) was established between MI and MIB-1 LI of OPMLs and MLs. Conclusion: Ki-67 expression was found correlated with the progression of disease from OPMLs to MLs. Therefore, it is considered a proliferative marker that corresponds with disease progression. Both proliferative indices (MI and MIB-1 LI) are positively correlated.
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Comparison of the locoregional outcome, toxicities, and compliance between hypofractionated and conventional chemoradiotherapy for head-and-neck cancers p. 21
Jyoti Sharma, Anushree Loyal, Shikha Dhal, Sumit Goyal, Tapan Kapoor, Ishitaa Rajendra, DP Singh
Introduction: Head-and-neck cancer (HNC) treatments are elusive, and the hunt for an appropriate radiation strategy continues. Hypofractionation has the potential to provide several advantages, including a shorter overall duration that reduces rapid repopulation, dosage escalation with a higher biologically effective dose, and patient convenience. Hypofractionation is also beneficial in minimizing the danger of catching an infectious agent by reducing the number of hospital visits during the height of the COVID-19 epidemic. Materials and Methods: Between January 2020 and August 2021, 120 patients with squamous cell carcinoma of the head-and-neck subsites were randomly allocated to either the hypofractionated arm A (n = 60) or the standard fractionation arm B (n = 60) with concomitant treatment. Results: Locoregional tumor response, acute and late toxicity, and compliance were the study's endpoints. The normal tissue toxicities of each patient undergoing radiation were monitored weekly. Clinical and radiographic evaluations of locoregional control were conducted. Conclusion: Hypofractionation effectively overcomes tumor repopulation in rapidly growing tumors such as HNC, and we conclude in our study that the hypofractionated chemoradiation schedule appears to be more efficacious, with relatively superior locoregional control when compared to conventional chemoradiation with comparable normal tissue toxicities and compliance.
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Hydration therapy to improve amniotic fluid index and its association with improved obstetric outcome in a teaching hospital of Eastern India p. 26
Jhuma Biswas, Swarnakamal Mondal, Shyamal Dasgupta, Mousumi Datta, Nasima Khatun, Lakavath Jyothi
Introduction: Oligohydramnios is associated with fetal complications and a higher incidence of maternal operative morbidity. A study was planned to determine the effect of hydration therapy in the correction of oligohydramnios in pregnancy and to assess if improvement in amniotic fluid index (AFI) is associated with better obstetric outcomes. Materials and Methods: Analytical study with a prospective design, conducted over 1 year from July 2020 to December 2021. Pregnant women in their third trimester with singleton pregnancy and intact membranes, diagnosed to have oligohydramnios were the participants. All women undertook oral rehydration therapy. The proportion of women achieving posthydration cutoff values of AFI and single deepest vertical pocket, was recorded by abdominal ultrasound examination at 24, 48, and 72 h. Adequacy of hydration was assessed by urinary specific gravity, before and after hydration therapy. Results: There were 120 participants. The mean age of the participants was 25.6 years (standard deviation = 5.7). Majority were multigravida. About 60%–80% of women improved with hydration therapy and the proportion of women showing improvement increased with time. Women with uncorrected AFI (<5 cm) at 24 and 48 h had significantly higher odds of preterm delivery, cesarean delivery, low-birth-weight baby, baby having 5 min Apgar score < 6, higher likelihood of Sick Newborn Care Unit admission and neonatal death. Conclusion: Maternal hydration therapy can be of value to improve the fetomaternal outcome in pregnancies with oligohydramnios by preventing preterm termination and reducing cesarean deliveries with good neonatal outcomes. Such simple intervention can be home based and assures universal health coverage.
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Association of nonalcoholic fatty liver disease with coronary artery disease in type 2 diabetes mellitus: A cross-sectional study from a tertiary care medical college hospital p. 31
Neelakandan Ramya, Golepu Karthikeya, Sethu Prabhu Shankar
Introduction: Nonalcoholic fatty liver disease (NAFLD) is a risk factor for increased morbidity, mortality, and cardiovascular disease. This study was done to assess the association of NAFLD with coronary artery disease (CAD) in type 2 diabetes mellitus. Materials and Methods: The study was done as a cross-sectional study in a tertiary care medical college hospital for 2 years among 218 adults patients of both sexes with type 2 diabetes mellitus. The study protocol was approved by the institutional ethics committee of the hospital. Age, sex, lifestyle, hypertension, personal history for smoking, and details of any previous CAD were recorded. Electrocardiogram (ECG) and ultrasonography of the abdomen were done. The association of NAFLD in type 2 diabetes mellitus patients with symptoms of angina according to modified rose and ECG changes using Minnesota codes was studied. Data collected were analyzed with Statistical Package for the Social Sciences (SPSS) version 20. Results: Of the total 218 diabetic patients, there were 92 (42.2%) were in the age group of 65–74 years. One hundred and forty-two (65.1%) had NAFLD and 76 (34.9%) had normal liver. Eighty-eight males and 54 female diabetic patients had NAFLD. Of the NAFLD patients 88 (58%) were smokers, 77 (54%) were obese, and 72 (51%) had hypertension. Low-density lipoprotein was increased in 132 (93%) patients with NAFLD. Angina symptoms according to modified rose questionnaire was present in 26 (18%) of NAFLD patients. Probable ST/T and Q/QS ECG changes according to Minnesota coding was present in 32 (22.53%) and in 26 (18.3%) of diabetic patients with NAFLD. Conclusion: There is significant association of coronary artery disease and cardiovascular risk factors with NAFLD in type 2 diabetes.
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Nutritional status of tribal under-five children in a community development block of birbhum district, West Bengal: A cross-sectional study p. 36
Prosun Goswami, Amitava Chakraborty, Kaushik Mitra, Dilip Kumar Das, Soumalya Ray
Introduction: One of the essential components for maintaining health is having proper and adequate nutrition. The absence of this might affect majorly the physical domain of health, especially in under-five children as it is the age of development. The present study was conducted among the tribal under-five children in a tribal predominant block, Mohammad Bazar in Birbhum District of West Bengal to find out their nutritional status, along with the estimation of prevalence of anemia among them; and the association, if any, between the nutritional status of the study population with their demographic, socioeconomic, and environmental characteristics. Materials and Methods: This community-based cross-sectional study was conducted among 378 tribal under-five children residing in 21 villages of Mohammad Bazar Block during September 2018–August 2020 using Lot Quality Assurance Sampling (LQAS) technique. A predesigned, pretested schedule was used to collect necessary information regarding background characteristics. Anthropometric measurements (height and weight) and biochemical estimation (hemoglobin level in blood) were done to evaluate nutritional status. Ethical permission was obtained from Institutional Ethics Committee, Burdwan Medical College. Data were analyzed using the Statistical Package for the Social Sciences, version 20. Results: The present study showed that 31.0% of under-five children were underweight, 16.6% severely underweight, 31.5% stunted, 17.2% severely stunted, 21.7% wasted, and 7.7% severely wasted. Nearly one-third of the study participants were suffering from anemia and most of them (91.5%) had mild anemia. As per LQAS, none of the villages had acceptable nutritional status as far as the weight for age and height for age was concerned. Conclusions: This research unveiled that the undernutrition in various forms still persists among the tribal under-five children. Rigorous implementation of various schemes, missions, and programs by both state and Central Government are the need of the hour to overcome this downhearted situation.
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Age-appropriate feeding practices and nutritional status of slum-dwelling young children in Kolkata during COVID-19 pandemic: A cross-sectional study p. 43
Nivedita Das, Supantha Chatterjee, Dipta Kanti Mukhopadhyay, Soumalya Ray, Mrittika Sarkar, Moumita Seal
Introduction: COVID-19 pandemic was postulated to affect the infant and young child feeding (IYCF) practices and their nutritional status. This study was planned to assess IYCF practices and nutritional status of infant and young children residing in slum areas and their association with selected background characteristics. Materials and Methods: A community-based, cross-sectional study was conducted in slums of Kolkata Municipal Corporation among 161 mother–child dyads from October to December 2020. After obtaining informed consent, mothers were interviewed to collect information about their socioeconomic status, hardship faced during pandemic, and IYCF practices of their children using indicators proposed by the World Health Organization and Government of India. Weight and height were measured using the standard operating protocol. The proportion was used to express descriptive statistics. Binary logistic regression models were used for calculating the adjusted odds ratio (AOR) using PSPP (v 1.20). Results: Only 64 (39.8%) children received age-appropriate feeding; 73 (45.3%) had single/multiple anthropometric failure(s). Reduction of family income was reported by 142 (88.2%) respondents. Children aged 6–8 months (AOR = 17.08, 6.43–45.42) were more likely to not have appropriate feeding. Association of female gender (AOR = 2.00, 1.01–4.00), maternal education less than middle class (AOR = 2.58, 1.22–5.46), and lack of appropriate feeding (AOR = 2.57, 1.08–6.12) were statistically significant with the presence of anthropometric failure. Conclusions: The study revealed a dismal scenario of child feeding and nutritional status of young children in the urban slums of Kolkata. Pandemic and imposed restrictions hit the families hard by reducing income and increasing food-related costs.
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Clinico etiological profile of “first seizure” in children. Experience from an armed forces tertiary care hospital in eastern India p. 49
Aparajita Gupta, Reema Solanki, Shuvendu Roy, Sangram Chakrabarty
Introduction: Seizure in the pediatric group is one of the most common emergencies encountered. The aim of this study was the evaluation of the etiology of a first episode of seizure in children so as to assess the short term as well as long-term prognosis. Materials and Methods: We evaluated 86 children 2 months − 12 years presenting to the emergency/outpatient department with the first episode of seizure. Children were further sub-grouped into two age groups of 2 months − 5 years (n = 60) and 5–12 years (n = 26) and acute symptomatic versus unprovoked seizures. Variables assessed were demographics, seizure semiology, laboratory tests, neuroimaging, and outcome at discharge. Results: 69.7% and 30.2% of children were in the age group 2 months to 5 years and 5–12 years, respectively. The mean age of the children was 4.11 ± 3.44 years. 45.3% of cases of acute symptomatic seizures and 54.6% of cases of unprovoked seizures were observed. Acute symptomatic seizures predominated in 2 months − 5 years (60%) while unprovoked seizures predominated in 5–12 years (88.4%). Focal seizures were predominant in the older age group (46.1%) as compared to the younger age group. About 10.4% of cases of seizures first presented as status epilepticus. The most common etiology identified was febrile seizures (27.9%) followed by central nervous system (CNS) structural lesions (19.7%) and CNS infections (10.4%). CSF was done in 18.6% of patients out of which 56.25% samples were positive for CNS infections. 68.6% of children underwent neuroimaging and abnormalities were reported in 67.7% of cases. About 18.6% of children had focal neurological deficits at discharge. Mortality in the entire cohort was 2.3% with 1 child in each vascular and CNS infections group. Conclusions: Children with a first episode of seizure should be evaluated for co-existence of fever, preexisting developmental delays, other associated symptomatology, head trauma, and seizure semiology. Investigations should be done based on a detailed history and clinical examination. Despite a meticulous approach allowing identification of etiology of the first episode of seizure in children, it is possible that no etiology be identified in a substantial number of children, especially in the older age group.
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Utility of bain's circuit to deliver respiratory support in a resource-limited setting during the COVID-19 pandemic p. 54
Ashish Kumar Simalti, Mehak Bansal, Badal Parikh, Aikaj Jindal, Sonal Singh
Introduction: Patients with COVID pneumonia, who did not respond to high-flow oxygen by nonrebreathing mask (NRBM), needed additional support to deliver oxygen with pressure. We present our innovation to use Bain's circuit to deliver continuous positive airway pressure (CPAP) along with 100% oxygen in patients with COVID-19 when there was a shortage of respiratory support equipment. Materials and Methods: It is a retrospective observational study conducted at two high-volume, government-designated, tertiary level COVID centers of Northern India, during May and June 2021. After taking informed consent from all patients included in the study, a nonventilated noninvasive ventilation (NIV) mask was used as the interface between Bain's circuit and the patient for making a tight seal. Vital parameters were recorded on admission, before putting the patient on Bain's circuit, at 30 min, and 6 h after the initiation of Bain's circuit. Results: Forty-five patients were enrolled in this study. There was a significant reduction in the work of breathing after the application of Bain's circuit. Vital parameters show improvement of the condition. Sensorium also showed a significant improvement after the application of Bain's circuit. Overall, 40% of patients who received Bain's circuit were weaned off to oxygen by NRBM, 31.1% of patients were bridged to NIV, and 28.9% of patients got intubated. Conclusion: The aim of presenting our experience is to generate interest regarding innovations in the face of crisis which may not be perfect but are practical for the situation. We do not recommend the use of Bain's circuit to provide NIV support under normal circumstances. Further studies are needed to support the use of Bain's circuit with modifications as a CPAP/NIV delivering device in selected patients.
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Morphometric analysis of human fetus and fetal pancreas in different gestational age groups p. 60
Bharti Jakhar, Rashmi Malhotra, Kanchan Bisht, Ravi Kant, Ashok Singh, Kavita Khoiwal, Brijendra Singh
Introduction: Fetal biometric parameters are very often utilized for calculating gestational age. The pancreas is a gland with dual functions in our body – exocrine and endocrine, with the latter component being very often discussed in the context of diabetes mellitus. Through evaluation of variations in morphometry in relation to different gestational ages, the research intends to draw attention to various associated developmental correlations that were not mentioned in previous studies. Materials and Methods: The current research was carried out on 30 fetuses after obtaining due approval from Institute's Ethical Committee. Fetuses were divided into different gestational age groups and morphometric parameters such as crown-rump length, crown heel length, head circumference, abdomen circumference, chest circumference, hand length, and Foot Length (FL) were noted by measuring with nylon thread in centimetres. Fetal pancreases were removed after stepwise dissection and pancreatic weight along with length and thickness was measured by Vernier calipers. All the parameters were then compared within different gestational age groups. Results: All the parameters and the age group of fetuses were positively correlated and showed statistical significance. Conclusion: The study would add substantial knowledge in the areas of pancreatic regeneration, surgical pancreatectomy, and treatment protocols for diabetes mellitus and pancreatic cancer. Through evaluation of variations in morphometry in relation to different gestational ages, the research intends to draw attention to various associated developmental correlations.
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Role of hematological and inflammatory markers in early diagnosis and severity of COVID-19 disease p. 73
Seema Awasthi, Ankita Mittal, Vivek Singh, Ashutosh Kumar, Faiyaz Ahmad, Nilisha Sharma
Background: COVID-19 virus, causing severe acute respiratory illness (SARS-CoV-2), was declared as a pandemic by the WHO in March 2020, after its first outbreak in China at the end of 2019. The major purpose is to establish the role of a hematological and inflammatory markers in early diagnosis of COVID-19 illness and its relationship with the disease severity. Materials and Methods: The study was performed in a tertiary care center from April to September 2020. The study included 150 hospitalized COVID-19 Reverse transcription-polymerase chain reaction positive patients. According to ICMR standards, research patients were grouped into mild, moderate, and severe categories depending on clinical evaluation. Different laboratory parameters complete blood counts, prothrombin time (PT), activated partial thromboplastin time (APTT), d-dimer, serum ferritin, C-reactive protein (CRP), and mean results are compared among the patient in three disease severity groups. Results: In the studied population, there were 106 (70.7%) males and 44 (29.3%) females. The average age of the research participants was 48.40 ± 11.50 (21–75 years), with majority of patients being old (>60 years). Hematological markers such as total leukocyte count, Neutrophil-to-lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) and the levels of PT, APTT, and D-dimer, as well as ferritin and CRP, all were considerably high with different groups of disease severity (P = 0.001). Conclusion: The study concluded that patients of severe disease category have significantly higher levels of leukocytosis, neutrophilia, elevated NLR, PLR, PT, APTT, D-dimer, serum ferritin, and CRP. Hematological and coagulation symptoms are associated with COVID-19 illness, and these indicators might be employed as a prognosticator for prediction of early disease severity.
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Relationship between peer pressure and initiation of smoking and alcoholism among the college-going students of Kolkata: A case–control study p. 78
Saikat Bhattacharya, Atanu Roy, Soumitra Mondal, Kaushik Mitra
Introduction: Substance abuse is now steadily increasing in the adolescent age group across the globe. Pressure to blend in with substance-using peers is an important predictor of substance abuse among adolescents. Smoking and alcohol intake are the two most common forms of substance abuse. Hence, this study tried to explore the effect of peer pressure on both substance users and nonusers and tried to find the adjusted effect of that pressure on substance abuse focused on smoking and alcohol intake. Materials and Methods: A case–control study was conducted on college-going students from various colleges and institutions in Kolkata during September and October 2021. The sample size for this case–control study was calculated taking confidence level at 99% and power 90%. Case and control ratio was taken as 1:1. Age-based matching was ensured. Further matching among the cases and controls was done based on gender. Data were collected by investigators using a pretested self-administered questionnaire that particularly focused on peer pressure along with some demographic factors. The questionnaire was distributed via electronic media and was circulated on various social platforms. A modified Peer Pressure Inventory containing 8 factors was created to evaluate the effect of peer pressure, and the Likert scale was used to score the responses of the participants. The odds ratio for the effect of peer pressure on smoking and drinking was calculated with a 99% confidence interval separately. Risk calculation was performed by multiple logistic regression to describe predictability and adjusted odds ratio of peer pressure on initiation of substance abuse. Results: The odds of the effect of peer pressure on initiation of drinking are 24.008 times higher. We also found that 53.62% of the cases have been drinking alcohol for at least 12 months. The odds of peer influence on initiating smoking tobacco were calculated to be 31.320. We found that 84.38% of the smokers had been subjected to significant peer pressure while 85.29% of the control subjects had not been subjected to significant peer pressure. Conclusion: Odds of peer pressure on smoking and alcohol initiation is quite high. Staying alone for more time has a protective effect on initiation of substance abuse.
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Clinical history: The forgotten connecting link between patient and cutting-edge technology p. 83
Sanjay Singhal, Kunal Khanderao Deokar, Gayatri Bhatia
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