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Review Article
Smit Singla, Akhilesh Verma, Snehil Goyal, Itika Singla, Anjali Shetty

Conventional and Advanced Diagnostic Tools in Oral Cancer with Emphasis on Role of Dentist and Early Detection

[Year:2017] [Month:July-September] [Volumn:51 ] [Number:3] [Pages:40] [Pages No:128-133][No of Hits : 4786]


ABSTRACT

The prevalence of oral cancer is increasing worldwide day by day. Those who suffer from oral cancer have low survival rate compared with other cancer, mainly due to delay in the diagnosis, metastases, and presence of secondary tumors. For the dental profession, it is really challenging to diagnose oral precancer or oral cancer, particularly in its early stage of the disease. Early screening and advanced diagnostic tools play an important role in the early diagnosis and treatment planning of patients suffering from oral cancer. The diagnosis method usually includes histopathology and visualization adjuncts, such as toluidine blue, vizilite, etc. This study reviews the development of new upcoming tools for early detection, emphasis on the importance of role of dentist, and early detection of oral cancer.

Keywords: Early detection, Oral cancer, Screening.

How to cite this article: Singla S, Verma A, Goyal S, Singla I, Shetty A. Conventional and Advanced Diagnostic Tools in Oral Cancer with Emphasis on Role of Dentist and Early Detection. J Postgrad Med Edu Res 2017;51(3):128-133.

Source of support: Nil

Conflict of interest: None


 
Original Article
Tvisha Ketan Parikh, S Arumugam

Are Indian Habits of Cross-legged Sitting and Squatting associated with Anterior Knee Pain?

[Year:2017] [Month:January-March] [Volumn:51 ] [Number:1] [Pages:51] [Pages No:1-6][No of Hits : 1191]


ABSTRACT

Aim: To evaluate the association between anterior knee pain (AKP) and traditional Indian habits of cross-legged sitting and squatting which involve deep knee flexion.

Materials and methods: A case control study was carried out in 225 patients and 225 age and sex matched controls at a tertiary care university hospital in South India over 3 years. Males and females between 18 and 55 years were evaluated using a clinical proforma of history and musculoskeletal examination. The details of deep knee flexion habits with quantification of duration were noted and participants were categorized into those who sat and did not sit cross legged, and squatters and nonsquatters. Odds ratios and chi-square tests were calculated for both these categorical variables. A subgroup analysis and stratified analysis were also performed.

Results: The Odds ratios for cross-legged sitting and squatting were not significant at 0.88 and 0.92 respectively. Sixty-nine point three percentage of the AKP cases and 72% of the controls sat cross legged (p = 0.534) and 67.6% of the AKP cases and 69.3% of controls habitually squatted (p = 0.685). Stratified analysis revealed a protective effect of cross legged sitting in AKP cases with quadriceps muscle tightness.

Conclusion: This study did not find an association between AKP and Indian habits of deep knee flexion. More than 65% of all the participants regularly engaged in these habits. Laboratory biomechanical analysis of these positions is suggested in future to understand their effect on knee joint.

Clinical significance: These positions are integral to daily habits of many Indians. The advice to AKP patients to avoid them due to their probable AKP association is not supported by the current study. Clinicians can consider the impact on the patient’s quality of life before advising against these positions.

Keywords: Anterior knee pain, Cross-legged sitting, Indian habits, Squatting,

How to cite this article: Parikh TK, Arumugam S. Are Indian Habits of Cross-legged Sitting and Squatting associated with Anterior Knee Pain? J Postgrad Med Edu Res 2017;51(1):1-6.

Source of support: Nil

Conflict of interest: None


 
Case Report
Nagarajan Doraisamy, Malarvizhi Chandrasekhar, Jim Jebakumar, Sukhdev DB Singh

Tuberculous Compound Palmar Ganglion

[Year:2017] [Month:January-March] [Volumn:51 ] [Number:1] [Pages:51] [Pages No:28-29][No of Hits : 880]


ABSTRACT

Introduction: Compound palmar ganglion of tuberculous etiology is an infrequent condition, which has an obvious clinical picture, but still overlooked and should be diagnosed earlier before the involvement of underlying bones and nerves.

Case report: We present the case of a 56-year-old male presenting with progressive swelling of the palm and forearm. He was diagnosed to have chronic flexor tenosynovitis without involvement of the underlying bones and was treated by complete excision and antitubercular therapy (ATT).

Conclusion: Tuberculous palmar ganglion is a condition that can be managed by excision and chemotherapy. However, it presents as a challenge to rural surgeons where the patients present late. Hence, early identification and treatment are the main goals of this article.

Keywords: Antitubercular therapy, Chronic flexor tenosynovitis, Compound palmar ganglion, Melon-seed bodies.

How to cite this article: Doraisamy N, Chandrasekhar M, Jebakumar J, Singh SDB. Tuberculous Compound Palmar Ganglion. J Postgrad Med Edu Res 2017;51(1):28-29.

Source of support: Nil

Conflict of interest: None


 
Review Article
Mushtaq A Shaikh

Intraoperative Neurophysiological Monitoring in Spine Surgery

[Year:2017] [Month:April-June] [Volumn:51 ] [Number:2] [Pages:61] [Pages No:89-94][No of Hits : 783]


ABSTRACT

Intraoperative neurophysiological monitoring (IONM) encompasses a variety of neurological testing modalities used during surgery to monitor, identify, and potentially prevent iatrogenic complications to the nervous system and the blood supply to it or adjacent tissue. It has been used to monitor integrity of the neural pathway during spinal, neurological, cranial, and vascular procedures. Specific tests are designed to the clinical need of the surgery. Modalities may include: Somatosensory evoked potentials, motor evoked potentials, spontaneous or triggered electromyography, brainstem auditory evoked potentials, visual evoked potentials, electroencephalogram, and electrocorticography. During spinal surgery, a wide variety of procedures are utilized in which the spinal cord, nerve roots, and key blood vessels are frequently placed at risk from iatrogenic injury. Multimodal IONM relies on the strengths of different types of neurophysiological modalities to maximize the diagnostic efficacy in regard to sensitivity and specificity in the detection of impending neural injury. Thorough knowledge of the benefits and limitations of each modality helps in optimizing the diagnostic value of IONM during spinal procedures. As spinal surgeries continue to evolve, the value of neuromonitoring will also continue to become more prominent.

Keywords: Electroencephalography, Electromyography, Motor evoked potentials, Sensory evoked potentials.

How to cite this article: Shaikh MA. Intraoperative Neurophysiological Monitoring in Spine Surgery. J Postgrad Med Edu Res 2017;51(2):89-94.

Source of support: Nil

Conflict of interest: None


 
Review Article
Vinay Jasani

Congenital Scoliosis

[Year:2017] [Month:April-June] [Volumn:51 ] [Number:2] [Pages:61] [Pages No:95-102][No of Hits : 696]


ABSTRACT

Congenital scoliosis is a scoliosis that occurs as a result of bony abnormalities that arise between 4 to 16 weeks of gestation. There are genetic and environmental factors involved in etiology. The majority of congenital vertebral anomalies are in the thoracic spine (64%).
The patients often have associated skeletal anomalies and can also be part of a syndrome. Skeletal, cardiac, genitourinary intraspinal abnormalities are most commonly found in association with congenital scoliosis.
The natural history seems to be related to the morphology of the bony the site in the spine, and the patient’s age. Congenital scoliosis usually progresses and often requires intervention. The aim of intervention is to achieve a flexible and balanced spine with normal truncal height and space available for lung ratio. Early intervention for scoliosis seems to be instrumental in trying to achieve these goals.

Keywords: Congenital, Hemivertebra, Scoliosis, Segmentation.

How to cite this article: Jasani V. Congenital Scoliosis. J Postgrad Med Edu Res 2017;51(2):95-102.

Source of support: Nil

Conflict of interest: None


 
Original Article
Dhaval Ranjitbhai Lekhadia, Rohan Rai, Niveditha Hegde, Gautham Hegde, Abhinay Sorake, Anil Kumar

Assessment of Vertical Skeletal Patterns using a New Cephalometric Parameter: The Dhaval Rohan Angle

[Year:2017] [Month:January-March] [Volumn:51 ] [Number:1] [Pages:51] [Pages No:7-11][No of Hits : 680]


ABSTRACT

Introduction: The aim of this study was to establish a new cephalometric parameter, named the Dhaval–Rohan angle (DR), to assess the vertical skeletal patterns on a lateral cephalogram with accuracy and reproducibility.

Materials and methods: One hundred and twenty pretreatment lateral cephalograms of the patients visiting the department of orthodontics and dentofacial orthopedics for treatment were obtained and divided into three groups. i.e., horizontal growth pattern, average growth pattern, and vertical growth pattern cases based on the routinely used cephalometric parameters; FMA, SN-GoGn, Y-axis angle and Jarabak ratio. This angle uses three skeletal landmarks, the point C (center of the condyle), point M (midpoint of premaxilla), and point G (center of the largest circle that is tangent to the internal inferior, anterior, and posterior surfaces of the mandibular symphysis).

Results: The one-way analysis of variance (ANOVA) test showed that the three groups studied were not the same for DR angle and the post hoc Tukey test found the groups to be significantly different. According to the Student’s t-test, there was no statistically significant difference in mean values of DR angle between males and females.

Conclusion: Cephalometric evaluation of young adults shows that the DR angle below 28.5° indicates a horizontal growth pattern, between 28.5 and 32.5° indicate an average growth pattern and above 32.5° indicate a vertical growth pattern.

Keywords: Growth pattern, Point C, Point G, Point M.

How to cite this article: Lekhadia DR, Rai R, Hegde N, Hegde G, Sorake A, Kumar A. Assessment of Vertical Skeletal Patterns using a New Cephalometric Parameter: The Dhaval–Rohan Angle. J Postgrad Med Edu Res 2017;51(1):7-11.

Source of support: Nil

Conflict of interest: None


 
Review Article
Amrut U Borade, Filippo Familiari, Kyubo Choi, Jacob Joseph, Edward G McFarland

Comparison of Reverse Total Shoulder Arthroplasty vs Hemiarthroplasty for Acute Fractures of the Proximal Humerus: Systematic Review

[Year:2017] [Month:October-December] [Volumn:51 ] [Number:4] [Pages:51] [Pages No:182-187][No of Hits : 622]


ABSTRACT

The optimal treatment of proximal humerus fractures is debated; however, reverse total shoulder arthroplasty (RTSA) has become increasingly popular as the primary treatment. We systematically reviewed the PubMed, EMBASE, and Scopus databases to identify English-language clinical studies (evidence levels I through IV) comparing the results of RTSA with those of hemiarthroplasty (HA) for the treatment of acute proximal humerus fractures. We evaluated the following outcomes: Range of motion, patient-reported outcome measures (including pain relief), and complications. We identified eight published studies comparing RTSA with HA for treatment of acute proximal humerus fractures. The RTSA group (180 patients) showed significantly better postoperative pain relief, active anterior elevation, Constant-Murley scores, and American Shoulder and Elbow Surgeons (ASES) scores compared with the HA group (439 patients; all p < 0.05). There were no significant differences between the two groups for overall complications (RTSA, 11.8% vs HA, 20.8%), infections (2% for both groups), dislocations (RTSA, 0% vs HA, 2.5%), or nerve injury (RTSA, 1% vs HA, 2.8%). Scapular notching occurred in 15.8% of RTSA cases (grade I, 53%; grade II, 32%; grade III, 16%; and grade IV, 0%). In the treatment of acute proximal humerus fractures, RTSA provided better pain relief, postoperative anterior elevation, and outcome scores after surgery compared with HA and had similar complication rates.

Keywords: Complications, Outcomes, Pain, Reverse total shoulder, Shoulder hemiarthroplasty, Surgery, Systematic review.

How to cite this article: Borade AU, Familiari F, Choi K, Joseph J, McFarland EG. Comparison of Reverse Total Shoulder Arthroplasty vs Hemiarthroplasty for Acute Fractures of the Proximal Humerus: Systematic Review. J Postgrad Med Edu Res 2017;51(4):182-187.

Source of support: Nil

Conflict of interest: None


 
Invited Article
Rajat Verma

Blood Conservation in Scoliosis Surgery

[Year:2017] [Month:April-June] [Volumn:51 ] [Number:2] [Pages:61] [Pages No:68-73][No of Hits : 542]


ABSTRACT

Spinal deformity correction surgery can result in significant blood loss. Historically, large volumes of allogeneic blood transfusion were used in these patients. There is now an increasing awareness of the need to reduce allogeneic transfusion as there are reported adverse effects. Reducing blood loss during scoliosis surgery is a multipronged approach. This study reviews current strategies to reduce requirements for allogeneic blood transfusion for scoliosis corrective surgery.

Keywords: Blood loss, Blood salvage, Blood transfusion, Scoliosis, Spine surgery.

How to cite this article: Verma R. Blood Conservation in Scoliosis Surgery. J Postgrad Med Edu Res 2017;51(2):68-73.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
John W Orchard, Rajesh Puranik, Christopher Semsarian, Jessica J Orchard, David Samra, Johan Duflou, Patrick Groenestein, Mark Young, Peter Brukner, Alex Kountouris

Prevention of Sudden Cardiac Death in Cricketers

[Year:2016] [Month:April-June] [Volumn:50 ] [Number:2] [Pages:72] [Pages No:49-58][No of Hits : 1892]


ABSTRACT

Aims: Sudden death in cricketers is rare, with the most common causes being cardiac, neurological (head/neck trauma, mainly from ball impact) and environmental (e.g., lightning strike and heat stroke, the former which usually involves cardiac arrest). The aim of this study was to review possible prevention of sudden cardiac death and make recommendations.

Materials and methods: A literature review of possible causes of sudden cardiac death (SCD) among cricketers was performed, along with evaluation of evidence for existing preventative measures. The method for evaluation was expert panel (cardiology and sports medicine) consensus recommendations based on the published evidence base.

Results: Potential cardiac causes of sudden death while playing cricket can be divided into the following categories: (1) atraumatic-origin preexisting arrhythmias, cardiomyopathies and valve disorders (2) traumatic-origin arrhythmia (commotio cordis) (3) acquired coronary or valvular disease (4) viral myocarditis (5) Lightning strike. Preventive measures can be divided into pre-season (e.g., cardiovascular screening), prematch (e.g., assessment of viral illness), protective equipment (e.g., chest guards) and post-event (presence of first aid response including defibrillators). Our panel agreed that there was strong evidence that (1) trained and planned emergency response particularly with a defibrillator is effective at preventing SCD and (2) ceasing play in the presence of lightning strikes prevents lightning-related death (3) players with symptoms, risk factors or history suggestive of possible cardiac disease should undertake specific individual workup. There are other potential methods to prevent SCD, with expert level recommendations made in the absence of strong evidence.

Discussion and conclusion: The most controversial aspect of prevention of SCD is electrocardiogram (ECG) screening of asymptomatic players and this paper outlines the arguments both in favor and against without fully resolving the debate. The possible increase in early diagnosis of potentially life-threatening cases needs to be balanced against the risk of false positive results which may lead to discussion of exclusion from cricket. Cardiac workup is clearly of net benefit to symptomatic individuals (e.g. history of syncope, chest pain) or any player at higher than usual baseline risk (e.g., positive family history). Basic life support including access to defibrillators should be available with trained personnel wherever they can be afforded, which has strong evidence in favor of improving survival at the time of cardiac arrest.

Keywords: Arrhythmia, Coronary artery disease, Cricket, Defibrillator, Electrocardiograph, Genetics, Prevention, Screening, Sudden cardiac death.

How to cite this article: Orchard JW, Puranik R, Semsarian C, Orchard JJ, Samra D, Duflou J, Groenestein P, Young M, Brukner P, Kountouris A. Prevention of Sudden Cardiac Death in Cricketers. J Postgrad Med Edu Res 2016;50(2):49-58.

Source of support: Nil

Conflict of interest: None


 
Original Research
Jyoti Rattan

Biotechnological Inventions and Patent Law: National and International Perspective

[Year:2016] [Month:July-September] [Volumn:50 ] [Number:3] [Pages:49] [Pages No:132-135][No of Hits : 1418]


ABSTRACT

In the knowledge society of 21st century, intellectual property rights (IPRs) are real assets and much more valuable and important than are materialistic assets like house, motor car, and so on. Patents are given for inventions which fulfill few important conditions, such as novelty, inventiveness, industrial application, and written description. Significantly, biotechnological invention involves monopoly over life or living beings or living processes, and morally and ethically these are considered to involve tinkering with life or nature. However, today, biotechnological inventions are patentable because of their benefits and utility to the industry. This article is a humble attempt to examine international and national law and judicial decisions relating to patents and biotechnological inventions from a theoretical perspective.

Keywords: Intellectual property rights, Nonnatural living beings, Novelty, Patent, World intellectual property organization.

How to cite this article: Rattan J. Biotechnological Inventions and Patent Law: National and International Perspective. J Postgrad Med Edu Res 2016;50(3):132-135.

Source of support: Nil

Conflict of interest: None


 
Research Article
Ruchi Saini, Sukhpal Kaur, Karobi Das

Stress, Stress Reactions, Job Stressors and Coping among Nurses Working in Intensive Care Units and General Wards of a Tertiary Care Hospital: A Comparative Study

[Year:2016] [Month:January-March] [Volumn:50 ] [Number:1] [Pages:47] [Pages No:9-17][No of Hits : 1305]


ABSTRACT

Literature has presented nursing as a stressful profession. The present study was conducted to compare stress level and job stressors operating in two different units, i.e. intensive care units (ICU) and general wards of a tertiary care hospital of North India. This is a cross-sectional study involving 285 nurses (general wards = 176; ICU = 109). The nurses were selected conveniently. Demographic profile sheet, modified workplace stress scale (WSS), workplace stress symptom scale (WSSS) and coping checklist (CCL) of Rao, Subbakrishna and Prabhu (1989) was used in the study. Findings of the study revealed moderate to high stress level among general wards and ICU nurses with young female nurses experiencing more stress. Further, workload, role ambiguity and lesser social support accounted for significant amount stress among nurses working on both the units while external factors, such as physical environment and resources hardly contributed to stress. It was also found that the ICU nurses experienced stress more in the form of exhaustion (11.9%); irritation (11.9%) and reduced self-confidence (0.9%) that those working in general wards. However, the nurses on both the units use distraction, positive coping, problem-solving and religious strategies to manage and handle their stress. The findings of the study give insight into stress and stressors related to job which can be buffered using various stress management strategies by the nurse managers.

Keywords: Coping, Job stressors, Nurses, Stress.

How to cite this article: Saini R, Kaur S, Das K. Stress, Stress Reactions, Job Stressors and Coping among Nurses Working in Intensive Care Units and General Wards of a Tertiary Care Hospital: A Comparative Study. J Postgrad Med Edu Res 2016; 50(1):9-17.

Source of support: Nil

Conflict of interest: None


 
Review Article
Nadeem Parvez, Surinder S Rana, Ritambhra Nada, Vishal Sharma, Ravi Sharma, Puneet Chhabra, Deepak Gunjan, Lovneet Dhalaria, Rajesh Gupta, Deepak K Bhasin

Appendicular Histology and Its Clinical Significance in Patients with Ulcerative Colitis: A Prospective Study from North India

[Year:2016] [Month:July-September] [Volumn:50 ] [Number:3] [Pages:49] [Pages No:141-147][No of Hits : 1298]


ABSTRACT

Background and aims: The appendix may be involved in ulcerative colitis (UC) to variable extent. Clinical significance of appendicular involvement is not clear and it has long been considered an innocent bystander. This study prospectively investigated appendiceal histology and its clinical significance in patients with UC.

Materials and methods: Colonoscopy was performed in 60 patients and biopsies were taken from appendiceal orifice, cecum, and colon. Appendiceal histology was classified as active if there was presence of neutrophils with crypt distortion. Inactive inflammation was defined as positive for crypt distortion and negative for neutrophils. Otherwise the histology was reported as normal or nonspecific changes. The patients were followed for a minimum period of 6 months.

Results: In patients evaluated endoscopically, 63% patients had histological involvement of the appendiceal orifice. Pancolitis was seen more commonly in patients with appendicular orifice inflammation than in patients with normal appendicular histology (44.7 vs 9%, p = 0.001). Most patients with appendiceal orifice inflammation had involvement of the cecum. Skip lesion of the appendix without cecum involvement was seen in 37% of the patients. The patients with appendiceal orifice inflammation had a significantly higher grade of endoscopic colitis compared to patients with normal histology (p = 0.006). Relapse rate was higher in patients with appendiceal orifice inflammation than in patients with normal appendiceal histology (18.4 vs 9%), although the difference was insignificant (p = 0.329).

Conclusion: Appendicular involvement in ulcerative colitis is not uncommon. Its involvement may predict the course, extent, and severity of colitis.

Keywords: Appendix, Colonoscopy, Inflammation, Ulcerative colitis.

How to cite this article: Parvez N, Rana SS, Nada R, Sharma V, Sharma R, Chhabra P, Gunjan D, Dhalaria L, Gupta R, Bhasin DK. Appendicular Histology and Its Clinical Significance in Patients with Ulcerative Colitis: A Prospective Study from North India. J Postgrad Med Edu Res 2016;50(3):141-147.

Source of support: Nil

Conflict of interest: None


 
Original Research
M Bhanukumar, Prasanna KH Ramaswamy, Naveen K Peddi, Vineetha B Menon

Mean Platelet Volume and Platelet Distribution Width as Markers of Vascular Thrombosis in Type 2 Diabetes Mellitus

[Year:2016] [Month:July-September] [Volumn:50 ] [Number:3] [Pages:49] [Pages No:127-131][No of Hits : 1105]


ABSTRACT

Aims: The objective of the study was to determine the mean platelet volume (MPV) and platelet distribution width (PDW) in subjects with type 2 diabetes mellitus (type 2 DM) compared to subjects without type 2 DM and their correlation with fasting blood glucose, glycosylated hemoglobin (HbA1c), and duration of type 2 DM respectively.

Materials and methods: A prospective analytical case-control study was conducted involving 50 subjects with type 2 DM and 50 subjects without type 2 DM. The mean and standard deviation were estimated for both the groups separately and independent Student’s “t”-test was used for evaluating the significant difference. The statistical evaluation was carried out at 95% confidence level.

Results: Mean MPV and PDW in case group was significantly higher compared to control group (p < 0.005). Fasting blood glucose, HbA1c, and duration of type 2 DM did not significantly alter MPV or PDW.

Conclusion: The study concludes that MPV and PDW are significantly increased in patients with type 2 DM compared to patients without type 2 DM. Platelet volume indices are an important, simple, and cost-effective tool that should be used and explored extensively, especially in countries, such as India, for predicting the possibility of impending acute vascular events in patients with type 2 DM.

Clinical significance: This analytical method helps us to use MPV and PDW as early markers of vascular thrombosis.

Keywords: Case-control study, Mean platelet volume, Platelet distribution width, Type 2 diabetes mellitus, Vascular thrombosis.

How to cite this article: Bhanukumar M, Ramaswamy PKH, Peddi NK, Menon VB. Mean Platelet Volume and Platelet Distribution Width as Markers of Vascular Thrombosis in Type 2 Diabetes Mellitus. J Postgrad Med Edu Res 2016;50(3):127-131.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Sameer Aggarwal, Nitesh Gahlot, Uttam Chand Saini, Mandeep Singh Dhillon

Bisphosphonates in Orthopedics: Evidence-based Review of Indications and Adverse Effects

[Year:2016] [Month:April-June] [Volumn:50 ] [Number:2] [Pages:72] [Pages No:75-85][No of Hits : 1035]


ABSTRACT

Bisphosphonates (BPs) are clinically the most important class of antiresorptive agents available to treat diseases characterized by osteoclast-mediated bone resorption. These agents have a potent effect on the skeleton and are in common use for treatment of osteoporosis, Paget’s disease, and metastatic bone disease in adults as well as in the treatment of pediatric disorders such as osteogenesis imperfecta, Perthes’ disease, and fibrous dysplasia. Although initial investigations had demonstrated an acceptable safety profile of bisphosphonate drugs, but recently this has been questioned by some authors. In this article, we review the chemistry, pharmacokinetics, and pharmacodynamics of these agents in brief and the orthopedic applications as well as adverse effects in detail.

Keywords: Adverse effects, Bisphosphonates, Indications, Review.

How to cite this article: Aggarwal S, Gahlot N, Saini UC, Dhillon MS. Bisphosphonates in Orthopedics: Evidence-based Review of Indications and Adverse Effects. J Postgrad Med Edu Res 2016;50(2):75-85.

Source of support: Nil

Conflict of interest: None


 
TECHNIQUE TIP
Shitij Kacker, Chandeep Singh, Sanjiv KS Marya

Modified extended Trochanteric Osteotomy

[Year:2016] [Month:April-June] [Volumn:50 ] [Number:2] [Pages:72] [Pages No:93-95][No of Hits : 1018]


ABSTRACT

Trochanteric osteotomy, the most extensile approach, is a valuable tool for difficult primary and revision total hip arthroplasties (THAs). Extended trochanteric osteotomy (ETO) is helpful in revision and extraction of well-fixed cemented as well as uncemented fremoral components, facilitates in cement extraction, and also in enhancing acetabular exposure. Tradional posterolateral ETO is initiated at the posterior aspect of the femur.
We describe a modification of ETO by an anterolateral approach. The advantage of this approach is that as it preserves an intact musculo-osseo-muscular sleeve comprising of gluteus medius and minimus, greater trochanter, and vastus lateralis it allows physiological reconstruction of hip’s soft tissue envelope and thus prevents proximal migration, nonunion of the osteotomy, and abductor lurch, which are the commonest complications associated with an ETO.
Anterolateral exposure of hip joint and anterior fibers of gluteus medius, minimus, and capsule reflected as cuff and limbs of osteotomy are marked, and after completing the osteotomy with the help of osteotomes passed from posterior to anterior, the fragment is hooked open on its anterior muscular hinge. Osteotomy is fixed with the help of three to four cerclage wires depending on length of osteotomy.
Full-weight bearing and abduction against gravity are only allowed after confirming radiological union of the osteotomy.

Keywords: Abductor lurch, Extended trochanteric osteotomy, Linea aspera.

How to cite this article: Kacker S, Singh C, Marya SKS. Modified extended Trochanteric Osteotomy. J Postgrad Med Edu Res 2016;50(2):93-95.

Source of support: Nil

Conflict of interest: None


 
Original Article
Amarjeet Singh, Smita Sinha

Risk Factors of Congenital Malformations in North India: A Case Control Study

[Year:2016] [Month:January-March] [Volumn:50 ] [Number:1] [Pages:47] [Pages No:22-27][No of Hits : 976]


ABSTRACT

An increasing incidence of congenital malformations (CMF) has been reported in India.

Objective: To ascertain the determinants of CMF.

Methodology: This hospital based age-sex matched pair case control study was done at advanced pediatric center (APC), obstetrics and gynecology department (ANC clinic, maternity ward, labor room, etc.) and special clinics, PGIMER, Chandigarh, India in 2008. The mothers were interviewed to collect information about risk factors.

Results: Two hundred three CMF (under five children and gestational CMF) cases and same number of controls were studied. Significant association of CMF was observed with the use of sex selection drugs by mothers (OR = 4.35), habits of fathers like taking alcohol (OR = 3), smoking (OR = 4.5) and using tobacco (OR = 2.7). Mother’s age at marriage < 18 years and history of abortion were also important predictors of CMF.

Conclusion: Most of the risk factors for CMF were avoidable viz. addiction, early marriage and use of sex selection drugs. People need to be educated about this.

Keywords: Antenatal care, Child health, Congenital malformations, Reproductive health, Sex selection.

How to cite this article: Singh A, Sinha S. Risk Factors of Congenital Malformations in North India: A Case Control Study. J Postgrad Med Edu Res 2016;50(1):22-27.

Source of support: Nil

Conflict of interest: None


 
Research Article
Amita Aggarwal, Bibek Adhya, Mandeep S Dhillon

Effectiveness of Isokinetic Exercises in Preoperative Anterior Cruciate Ligament Tears Rehabilitation

[Year:2016] [Month:January-March] [Volumn:50 ] [Number:1] [Pages:47] [Pages No:5-8][No of Hits : 968]


ABSTRACT

The present study compared the effectiveness of adding isokinetic exercise program to conventional rehabilitation protocol in preoperated patients with anterior cruciate ligament (ACL) tear. The subjects were randomly assigned into two groups (n = 10 each). Group A followed conventional rehabilitation protocol. In group B, isokinetic exercise for quadriceps and hamstring were advised. These consisted of 3 set of 10 repetitions at velocity of 60 and 120° sec. with 1 minute rest interval between the sets. The exercise protocol was performed 6 days a week for 4 weeks. Student t-test was used for analysis. Also subjects were evaluated for pain using visual analog scale (VAS). For the assessment of symptoms and functions Cincinnati knee rating system and Lysholm scoring scale were used. The effectiveness of isokinetic exercise was significantly better only with knee extension peak torque and peak work in case of quadriceps (p < 0.05). Hamstring testing showed no significant difference with isokinetic training in intragroup as well as intergroup comparison for any measured parameters. Also no significant differences were found with use of functional scales.

Conclusion: Isokinetic exercises are effective in improving quadriceps peak torque and peak work in patients with ACL tear.

Keywords: Anterior cruciate ligament tear, Isokinetic exercise, Rehabilitation.

How to cite this article: Aggarwal A, Adhya B, Dhillon MS. Effectiveness of Isokinetic Exercises in Preoperative Anterior Cruciate Ligament Tears Rehabilitation. J Postgrad Med Edu Res 2016;50(1):5-8.

Source of support: Nil

Conflict of interest: None


 
Original Article
Vikram Narang, Man US Sachdeva, Parveen Bose, Neelam Varma, Pankaj Malhotra, Subhash Varma

Immunophenotyping in Chronic Myeloid Leukemia Blast Crisis: Looking beyond Morphology

[Year:2016] [Month:October-December] [Volumn:50 ] [Number:4] [Pages:37] [Pages No:181-184][No of Hits : 955]


ABSTRACT

Introduction: Patients of chronic myeloid leukemia (CML) eventually transform to blast crisis (BC) after a variable length of chronic phase (CP). With improvement in management protocols, many patients of CML-BC are expected to show remission after initial chemotherapy and a better survival. Hence, it becomes imperative to correctly classify the nature of BC for further course of management.

Materials and methods: This study retrospectively analyzed cases of CML-BC, over a period of 5 years, with comprehensive immunophenotyping done on flow cytometry.

Results: Fifteen cases of CML-BC with male-to-female ratio of 3:1 and mean age of 40.2 years were included in the study. Flow cytometry revealed 14 cases of myeloid and one case of lymphoid BC. One case each of megakaryocytic and myelomonocytic lineage were seen among the 14 cases of myeloid BC. Aberrant marker expression was a common occurrence. Myeloperoxidase cytochemical stain had shown positivity only in 3 of the 14 cases of myeloid BC.

Conclusion: Immunophenotyping is necessary for assigning specific lineage to blasts in patients of CML-BC and thus providing clinically useful information regarding the treatment protocols and prognosis of the patient.

Keywords: Blast crisis, Chronic myeloid leukemia, Immunophenotyping.

How to cite this article: Narang V, Sachdeva MUS, Bose P, Varma N, Malhotra P, Varma S. Immunophenotyping in Chronic Myeloid Leukemia Blast Crisis: Looking beyond Morphology. J Postgrad Med Edu Res 2016;50(4):181-184

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Anil Chauhan, Manvi Singh, Nishant Jaiswal, Kiran Kumar Thumburu, Amit Agarwal, Shailender Singh Chauhan, Sunil Dhatwalia, Mananda S Bhende, Meenu Singh

Vitamin D reduces Exacerbation in Children with Asthma: A Systematic Review and Meta-analysis

[Year:2016] [Month:April-June] [Volumn:50 ] [Number:2] [Pages:72] [Pages No:86-92][No of Hits : 911]


ABSTRACT

Aim: The question whether treatment with vitamin D improves asthma exacerbations in children and adults still needs to be addressed.

Background: Recent studies in children and adults found a higher prevalence of hypovitaminosis D associated with a higher severity of asthma and impaired pulmonary function. In asthmatic children, patients with vitamin D deficiency demonstrated increased airway hyperresponsiveness and corticosteroid requirements

Results: Of 469 records/studies identified through database searching, 5 studies were included in this systematic review. The overall pooled effect showed a significant reduction in acute asthma exacerbation in the vitamin D group (odds ratio 0.45, 95% confidence interval 0.22-0.93). There were no studies that focus on the quality of life.

Conclusion: This systematic review supports the role of vitamin D in reducing the number of asthma exacerbations in children but not in adults.

Clinical significance: The present systematic review demonstrates reduction in asthma exacerbations in children. Most of the asthma children are on inhaled corticosteroid, which poses a threat for its side effects. However, vitamin D having multiple functions in body could be used as an alternative therapy in asthmatic children. In adults, more trials are needed wherein the deficient individuals are supplemented with vitamin D and further assessed for asthma exacerbations. There is no harm in supplementation of vitamin D to deficient and insufficient asthmatic individuals.

Keywords: Asthma, Exacerbations, Heterogeneity, Placebo, Pulmonary function test, Systematic review, Vitamin D.

How to cite this article: Chauhan A, Singh M, Jaiswal N, Thumburu KK, Agarwal A, Chauhan SS, Dhatwalia S, Bhende MS, Singh M. Vitamin D reduces Exacerbation in Children with Asthma: A Systematic Review and Meta-analysis. J Postgrad Med Edu Res 2016;50(2):86-92.

Source of support: The review was supported and funded by ICMR, New Delhi (grant number 5/7/592/11-RHN). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest: None


 
Original Article
Lavina Sodhi, Harinder Singh, Daisy Sahni, Tulika Gupta, Anjali Aggarwal, Kunal Chawla, Harjeet Kaur

Estimation of Age from Symphyseal Surface of Cadaveric Pubic Bones of Northwest Indian Male Adults

[Year:2016] [Month:October-December] [Volumn:50 ] [Number:4] [Pages:37] [Pages No:176-180][No of Hits : 762]


ABSTRACT

Introduction: Age estimation of dead persons of unknown age and identity from skeletal remains has an important role in legal and forensic investigations. Due to their relatively better ability to withstand the impact of physical forces and agents, the skeletal remains of human mortals provide us with wealth of information in the form of preserved morphological patterns or markings on bones. Out of all bones, morphological features on pubic bones are by far the best indicators. A large-scale study on pubic bones was conducted by a famous anatomist, Todd, in 1920, and since then his method is being followed for the assessment of age.

Materials and methods: Cadaveric pubic bones of 204 Northwest Indian adult males aged 18 to 61 years were taken for the study from the archive collection in museum of anatomy. Sixteen morphological features on the symphyseal surface of pubic bones were noted and arranged in 10 phases according to Todd’s (1920) method. Frequency of these features present in each phase was calculated. Linear regression analysis was applied to obtain an equation for estimation of age from a pubic bone of an unknown deceased individual.

Results: It was seen that frequency of most morphological features of the pubic bones in the present study age groups (phases) was 100%, i.e., similar to those in Todd’s study. There was a significant correlation (r = 0.9, p < 0.001) between the actual age of the pubic bone and age estimated by linear regression equation.

Conclusion: Despite numerous improved methods, Todd’s method remains the most useful method for determination of age. Appearance of morphological features on the symphyseal surface of pubic bones in the present study were similar to most phases of Todd’s study. Thus, Todd’s method can be successfully applied for the estimation of age in Northwest Indian adult male population.

Keywords: Age estimation, Morphological features, Northwest Indians, Pubic bones, Pubic symphysis.

How to cite this article: Sodhi L, Singh H, Sahni D, Gupta T, Aggarwal A, Chawla K, Kaur H. Estimation of Age from Symphyseal Surface of Cadaveric Pubic Bones of Northwest Indian Male Adults. J Postgrad Med Edu Res 2016;50(4):176-180.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
Rashmi Bagga, Vanita Suri, Radhika Srinivasan, Niranjan Khandelwal, Payal Keswarpu, Sarif Kumar Naik, Vidya Chandrasekhar, Lovi Gupta, Soubhik Paul

Feasibility of Using Mobile Smartphone Camera as an Imaging Device for Screening of Cervical Cancer in a Low-resource Setting

[Year:2016] [Month:April-June] [Volumn:50 ] [Number:2] [Pages:72] [Pages No:69-74][No of Hits : 730]


ABSTRACT

Objective: The aim of this study is to determine the feasibility of a screening method for cervical cancer using an application developed on smartphone to aid visual inspection with acetic acid.

Materials and methods: A prospective study was carried out in 230 women in the Department of Gynaecology, PGIMER, Chandigarh, India. These women were divided into two groups. Among the first group, screen positive women (n = 28) were examined by two gynecologists. In the second group (n = 202), healthcare workers screened women in a mobile van. The two groups were examined using the smartphone and digital colposcope. Abnormal findings were confirmed by liquid-based cytology and histopathology. The image quality of ColpPhon® was compared with colposcopic images as the gold standard. Kappa was used for comparison of ColpPhon® and colposcopic findings for final diagnosis.

Results: Among the 230 women screened, cervical intraepithelial neoplasia (CIN) was diagnosed in six cases by histopathology (CIN 2/3 in five and CIN 1 in one). These six women belonged to the group of 28 women examined in the colposcopy clinic. Both colposcope and ColpPhon® were able to identify these six women. The individual image quality parameters for ColpPhon® were slightly inferior to the colposcope. The overall image clarity had an agreement in 82% (184/225) as being either good or excellent. The diagnosis made on images acquired from each device had an agreement in 90% (208/230) of the cases.

Conclusion: This study demonstrates feasibility of incorporating a smartphone device to capture images of the cervix for improving cervical cancer screening in resource-poor countries.

Keywords: Cervical cancer, Early detection, Low-resource setting, Mobile device, Smartphone.

How to cite this article: Bagga R, Suri V, Srinivasan R, Khandelwal N, Keswarpu P, Naik SK, Chandrasekhar V, Gupta L, Paul S. Feasibility of Using Mobile Smartphone Camera as an Imaging Device for Screening of Cervical Cancer in a Lowresource Setting. J Postgrad Med Edu Res 2016;50(2):69-74.

Source of support: The study was supported by Philips India Ltd.

Conflict of interest: None


 
Research Article
Gaurav Khandelwal, Sunit Pathak, Manoj Sharma

Fusidic Acid Ointment in Treatment of Recurrent Epistaxis in Children

[Year:2016] [Month:October-December] [Volumn:50 ] [Number:4] [Pages:37] [Pages No:194-196][No of Hits : 656]


ABSTRACT

Aim: To establish fusidic acid ointment in the treatment of recurrent epistaxis in children as a local antiseptic.

Materials and methods: It was a retrospective study and a total of 184 pediatric patients’ data were analyzed. Ninety-seven patients were found to be fitting in selection criteria. The time of presentation, number of episodes, treatment received, and follow-ups were noted. Results were confirmed over the phone.

Results: Ninety-five patients had simple bleed and were managed on outpatient treatment with fusidic acid ointment and saline nasal drops, while two required admission and underwent electrocautery of offending vessel. Out of the 95 patients, 10 had initial failure of treatment in the 1st month, but with continued treatment were subsequently treated. Fifteen of these 95 had episodes in the next season. The incidence of bleeding was more in summers than winters in children.

Conclusion: Fusidic acid ointments are safe and effective in the treatment of recurrent epistaxis in children.

Clinical significance: The effectivity of fusidic acid in epistaxis has never been studied. This study can establish it as an antiseptic ointment in the treatment of recurrent epistaxis.

Keywords: Fusidic acid ointment, Pediatric epistaxis, Recurrent epistaxis.

How to cite this article: Khandelwal G, Pathak S, Sharma M. Fusidic Acid Ointment in Treatment of Recurrent Epistaxis in Children. J Postgrad Med Edu Res 2016;50(4):194-196.

Source of support: Nil

Conflict of interest: None


 
Case Report
Anjali Aggarwal, Tulika Gupta, Aditya Aggarwal, Daisy Sahni

Bilateral Variation of Lateral Root of Median Nerve traversing through Coracobrachialis Muscle

[Year:2016] [Month:July-September] [Volumn:50 ] [Number:3] [Pages:49] [Pages No:159-161][No of Hits : 634]


ABSTRACT

An unusual bilateral variation of lateral root of median nerve piercing through coracobrachialis muscle is presented. Two nerve filaments to coracobrachialis muscle took unusual origin from medial cord, which crossed the axillary artery from medial to lateral side before entering the muscle. Variation of lateral root of median nerve may be clinically significant, as hitherto unreported entrapment neuropathy of median nerve along with musculocutaneous may occur at the arm level while passing through coracobrachialis muscle or it may be injured during any surgical intervention around shoulder joint. Nerves to coracobrachialis are at risk during unusual abduction of arm or surgical manipulation of axillary artery.

Keywords: Coracobrachialis, Lateral root of median nerve, Musculocutaneous nerve.

How to cite this article: Aggarwal A, Gupta T, Aggarwal A, Sahni D. Bilateral Variation of Lateral Root of Median Nerve traversing through Coracobrachialis Muscle. J Postgrad Med Edu Res 2016;50(3):159-161.

Source of support: Nil

Conflict of interest: None


 
Case Report
Sanjay Yadav, Chandra Shekhar Yadav, Nishikant Kumar, Ashok Kumar

Every Knee is not Osteoarthritic, Spontaneous Avascular Necrosis of the Medial Tibial Condyle

[Year:2016] [Month:January-March] [Volumn:50 ] [Number:1] [Pages:47] [Pages No:33-35][No of Hits : 622]


ABSTRACT

Avascular necrosis (AVN) of tibial condyles is an uncommon cause of joint degeneration and it may mimic osteoarthritis. The differentiation between spontaneous and secondary osteonecrosis is important for appropriate management. We present here a case of spontaneous avascular necrosis of the medial tibial condyle causing sudden increase in pain; localization to the medial tibial condyle near joint line with exacerbation on weightbearing and varus deformity. We also aim to recapitulate briefly various types and currently available treatment options. In the present case, considering advanced stage of AVN and associated degenerative changes, total knee replacement (TKR) was performed successfully with good outcomes.

Keywords: Avascular, Necrosis, Tibial condyle, Total knee arthroplasty.

How to cite this article: Yadav S, Yadav CS, Kumar N, Kumar A. Every Knee is not Osteoarthritic, Spontaneous Avascular Necrosis of the Medial Tibial Condyle. J Postgrad Med Edu Res 2016;50(1):33-35.

Source of support: Nil

Conflict of interest: None