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   Table of Contents - Current issue
January-March 2021
Volume 8 | Issue 1
Page Nos. 1-91

Online since Tuesday, March 16, 2021

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Smartphone addiction p. 1
Sushil Kumar
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Effectiveness of oral pentosan polysulfate in painful bladder syndrome: Is it worth the cost? p. 3
Devdatt Purushottam Palnitkar, Prakash Patankar, Suresh Patankar
Introduction: Oral pentosan polysulfate (PPS) is a recommended treatment in painful bladder syndrome (PBS); efficacy and cost-effectiveness of PPS have not been compared against the treatment with anticholinergics. Aim: This pilot study compared the effectiveness of oral PPS and anticholinergics and the cost of treatment for both. Materials and Methods: Thirty consecutive female patients presenting in Urology outpatient clinics were included in the study after obtaining clearance from the research and ethics committee. Twelve patients in each arm A and B completed the course of treatment and follow-up. Patients in each group were comparable symptomatically and epidemiologically. The patients in group A received oral PPS 100 mg three times daily for 3 months, whereas the patients in group B received anticholinergic drugs (oxybutynin chloride 2.5 mg twice daily) for 3 months. Efficacy based on symptom score and quality of life (QoL) scores along with cost-effectiveness was compared between the two groups. Results: In relief of symptoms and improvement in the QoL, there was no statistical difference in the findings of the two groups. The cost of therapy for the two groups was significantly different (P = 0.09). The cost of treatment with PPS was higher by two to three times the cost of treatment in the other groups. Conclusion: PPS does not offer any therapeutic advantage over oxybutynin chloride and is a costlier form of treatment.
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CT chest interpretation of novel coronavirus disease (COVID-19): Our experience with the first 60 patients at MGM Medical College, Aurangabad, India Highly accessed article p. 9
Bano Nikhat, Meghana Deshmukh, Devidas B Dahiphale, PS Mishrikotkar, Saurabh Joshi
Introduction: In December 2019, the outbreak of a novel corona virus infection occurred in Wuhan City, China. Early discussions suggested that computed tomography (CT) should be the preferred modality for the diagnosis of COVID-19. However, the use of CT for COVID-19 diagnosis is controversial. Also, the detailed CT features of COVID-19 have been reported in only a small number of articles in the literature. Objective: To evaluate lung abnormalities on thin-section CT scans in patients with COVID-19. Materials and Methods: This study included the first 60 clinically suspected patients for COVID-19 infection. The patients have further investigated for COVID-19 infection by reverse transcription-polymerase chain reaction (RT-PCR) test and CT chest. We identified CT patterns suggestive of COVID-19 infection and calculated the total CT severity score. The imaging reports of the CT chest study were compared with the RT-PCR test results. Results: In our study, we had 37 male patients and 23 female patients. COVID-19 pneumonia was diagnosed in 55 of the 60 patients, but five patients did not show any commonly described findings of COVID-19 pneumonia. Of the 55 patients, the majority of them had ground-glass opacities. The bilateral lower lobes were involved in the majority of the cases. RT-PCR results show that, of the 60 patients, 37 were positive for COVID-19 and 23 were negative for COVID-19. The mean total lung severity score for the 60 patients was 11.5 (range, 0–25). Mediastinal lymphadenopathy was notably absent in all 60 patients and only five patients had traces of bilateral pleural effusion and only one patient had air trapping. In terms of the distribution of disease in the axial plane, peripheral distribution was found in most of the cases. The patients with higher CT scores required ICU admission and ventilator support, and had a poor prognosis. Conclusion: We found that chest CT may be useful as a standard method for the rapid diagnosis of COVID-19 to optimize the management of patients in hospital settings where nucleic acid testing kits are not available or available in limited quantities. Chest CT plays a crucial role in the early detection of COVID-19, particularly for those patients with a negative RT-PCR.
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Prevalence of dental fear in children of 3–14 years visiting the OPD in Dental College, Lucknow, India p. 15
Ankita Singh, Anuradha Palshikar, Sugandha Agarwal, Shweta Singh
Introduction: Dental fear and anxiety pose a significant problem for the practice of dentistry, especially in children. Therefore, it is necessary to identify and quantify this anxiety, to implement, and to monitor the effectiveness of treatment interventions. Materials and Methods: A cross-sectional study was conducted on children in the age group of 3–14 years. The children who had sound health and visited outpatient department of a Dental College, Lucknow, India with their parents for dental care were considered for study purposes. Children’s dental fear and anxiety were measured by using three scales. Result: Out of the total 220 respondents, 118 (53.6%) were males and 102 (46.4%) females. The outcome of the study showed that the dental fear among children was 13.3%, 22.9%, 7.8%, respectively, in existence measured by the three scales, viz., (a) facial image scale (FIS), (b) dental fear scale (DFS), and (c) children’s fear survey schedule-dental subscale (CFSS-DS). About 70.2% of the children showed Frankl’s behavior rating of 3, i.e. positive. Conclusion: Dental fear and anxiety are the most common problems of children and because of this, they are afraid of undergoing any dental treatment. By using the above scale, we can know about those factors which can enhance their fear so that we can modify our treatment approach. Altering in a treatment modality not only leads the children to get the treatment done easily but also removes the fear for dental treatment in the future.
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Assessment of Correlation between Smartphone Addiction, Social Anxiety, and Self-Esteem: A Cross-Sectional Study p. 22
Pandurang Vithal Thatkar, Jeevan P Tonde, Rajesh K Dase, Dattatray D Pawar, Rajavannian Chidambaram
Background: Research on smartphone and Internet addiction has increased rapidly, indicating its clinical and social significance. This study aimed at exploring the possible relationship between smartphone addiction, self-esteem, and social anxiety. Materials and Methods: A total of 464 young college-going adults participated in this study [male = 175 (37.71%), female = 289 (62.3%)] between the ages of 18 and 28 years old. The study participants were asked to complete a survey having three different questionnaires, namely “Smartphone Addiction Scale,” “Rosenberg’s Self-Esteem Scale,” “and the Interaction Anxiousness Scale.” This study also focuses on gender and age differences regarding smartphone addiction. Karl Pearson’s correlation coefficient and unpaired t-test were used to test the significance of the relationship among study variables. Regression analysis was performed to predict smartphone addiction by using Age, Rosenberg’s Self-Esteem Score, and Interaction Anxiousness Score. Results: The mean smartphone addiction scale (SAS) total score was higher in males as compared with females (P = 0.01). No significant difference was observed in RSE total score and IAS total score among males and females (P > 0.05). Significant correlations were observed among SAS total, RSE total, IAS total, and Age (in years) (P < 0.05). Regression analysis was applied to predict SAS total score by using independent variables such as age, RSE total, and IAS total. The coefficients for age and RSE total score were significant (P < 0.01), and the IAS total was not significant (P > 0.05). Conclusion: Males reported having higher smartphone addiction levels as compared with females. A positive correlation was observed between Social Anxiety and Smartphone addiction. A negative correlation was observed between self-esteem and smartphone addiction, which indicates that the lower the self-esteem, the higher will be the smartphone addiction. Age was negatively correlated with smartphone addiction score and social anxiety score, whereas age was positively correlated with self-esteem.
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Cross-sectional study regarding pattern of adverse drug reactions in a tertiary care hospital, Kakinada, India p. 29
Sreenivasa Rao Bendi, Tarun Kumar Suvvari, Lakshmi Venkata Simhachalam Kutikuppala
Introduction: Drugs are considered as double-edged weapons with the potential to cause benefit as well as harm. Recent studies reveal that adverse drug reactions (ADRs) imply a remarkable burden on the length of hospital stay, healthcare facilities, and sometimes they require additional investigations and drug therapies for the treatment of symptoms and diseases caused to the patient. So, further local studies are required to understand the scenario and to improve the safety of prescribing and monitoring drugs and improved patient adherence to medication. Objectives: To evaluate and assess the pattern of adverse drug reactions reported to the ADR Monitoring Centre, Rangaraya Medical College, Kakinada, India. Materials and Methods: The current study was a retrospective and an observational type of study carried out at the ADR Monitoring Centre of a tertiary care hospital. Total ADRs reported during the two years from June 2016 to June 2018 were included in the study. Each ADR was analyzed for demographic data, relationship to drugs as per causality assessment, and frequency of ADRs. Microsoft Excel 2019 and SPPS version 20 were used for data analysis. Results: The most common group of drugs showing ADRs were anti-retroviral therapy (ART) drugs, followed by anti-microbial agents. Most of the ADRs were probable and mild. Rash was the most frequently occurring ADR. Conclusion: The study of ADRs in a particular institute using demographic patterns will contribute to patient safety by sensitizing the clinicians in that particular institute.
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Repurposing of a muscle relaxant drug thiocolchicoside as an anticancer agent p. 33
Shreya Medhi, Simran Narvekar, Amrita Srivastav
Introduction: Conventional methods of drug discovery have somehow proved to be ineffective in terms of lengthy design, limited efficacy amongst multiple other reasons. Considering that “time” is an important factor in the process of drug discovery, it becomes necessary to look for newer methods. Drug repurposing can be considered as a suitable option in such scenarios; to treat cancer or diseases with rapid pathogenesis. Amongst the various types of cancer, breast cancer and more precisely triple-negative breast cancer (TNBC) has become a prevalent form. Objectives: To overcome the challenges of conventional methods, several bioinformatic tools may be used, particularly those involved in molecular docking (CASTp, Discovery Studio, AutoDock Tools, etc.). Materials and Methods: Thiocolchicoside is a semisynthetic drug that was traditionally used as an anti-inflammatory and analgesic. In this article, we repurpose thiocolchicoside to act mainly on the NF-kB pathway. RANK and RANKL are frequently detected in the oncogenic process and together they participate in cancer development through TRAF6 activating the NF-kB pathway. Molecular docking of thiocolchicoside against TRAF6-RANK can exhibit the potency of this drug against breast cancer. Results: It was observed that cell viability was decreased when different drug concentrations were used against TNBS cell lines in vitro as compared with the control sample. The cell viability observed was 100% in the control sample, 95.93% in 15.625 µM drug concentration, 62.33% in 31.25 µM, 55.56% in 62.5 µM, 53.66% in 125 µM, 44.17% in 250 µM, and 39.84% in 500 µM. Conclusion: Repurposing a drug with the help of molecular docking is an effective method of drug development that reduces the time and cost factor due to its already known safety. Molecular docking of thiocolchicoside against TRAF6-RANK exhibits its inhibitory effect, and it can be effectively used as an anticancer drug.
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In silico BRCA1 pathway analysis in breast invasive carcinoma p. 44
Zafar Abbas Shah, Faisal Nouroz, Asima Tayyeb
Recent developments in clinical patient-based personalized genomics explored a variety of biomarkers for diagnosis, prognosis, and therapy in breast invasive carcinoma (BRIC). BRCA1 mutations mediated a catastrophic situation for a damage-repairing apparatus that induced malignant transformation of breast tissue. To identify an association between BRCA1 regulatory behavior and the pathway-level proteome for determining drug discovery channels, here we developed a computational scheme for BRCA1 pathway dataset retrieval from PathCards: PATHWAY UNIFICATION DATABASE (1,073 superpaths of 3,215 human pathways from 12 sources), BRCA1 pathway regulation analysis from cBioPortal for Cancer Genomics (more than 40 datasets of above 13,000 cancer samples), and BRC1 network construction from STRING v11.0 database (24,584,628 proteins of 5,090 organisms). Our study reveals about 700 alterations of 64 pathway components in 482 BRIC samples, in which there were 422 loss-of-function (LOF) mutations and 278 amplifications. We found 19 members (BRCA1, BRCA2, FANCA, ATM, NBN, SMARCD2, HDAC9, PLK1, SMARCA4, POU2F1, TP53, HDAC2, HLTF, BLM, E2F4, UBC, E2F5, MRE11, and RB1) based on a minimum 2% participation that showed 541 alterations in which there were 193 amplifications and 348 LOF mutations. From 19 components, BRCA1, BRCA2, FANCA, ATM, and TP53 have high-level LOF mutations whereas E2F5, NBN, SMARCD2, and POU2F1 have prominent amplifications. We developed three modules in which the BRCA1 module has 12 members that are involved in damage sensing and repairing processes as hot spots showing overexpression and LOF mutations. This in silico approach uniquely addressed BRCA1 mutations’ influence on BRIC at the pathway proteome level, with module identification as a hub for drug designing. We proposed these proteins as biomarkers for first-class diagnosis and clinical investigations. In the future, BRCA1 pathway-related therapeutic markers are used for further experimental investigations regarding drug development in breast cancer biology.
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The practice of hand hygiene among undergraduate medical students p. 52
Gurjeet Singh, Raksha Singh
Background: Health care-associated infections (also called hospital-acquired or nosocomial infections) add to the morbidity and mortality and costs that one might expect from the underlying illness alone. All this has led to concerted efforts to implement infection control programs in all teaching hospitals, hospitals, and other health centers; the quality of such programs reflects the overall standard of care provided by the institution. The practice of hand hygiene is a simple yet effective way to prevent infections. Cleaning of the hands can prevent the spread of microorganisms, specifically those that are multidrug-resistant organisms (MDRO), and that are getting troublesome, if certainly feasible, to treat. These factors, compounded by the scarcity of accessibility of new antimicrobials, have required a relook into the function of essential acts of contamination counteraction in current medical services. Good hand hygiene practice, including the use of alcohol-based hand rubs and handwashing with soap and water, is critical to reducing the risk of spreading infections in ambulatory care settings. Aims and Objectives: This study was conducted to evaluate the knowledge, attitudes, and practices of hand hygiene of undergraduate medical students. Materials and Methods: A cross-sectional study was carried out at the Department of Microbiology, N.C. Medical College and Hospital, Israna, Panipat, Haryana, India, over six months from January 2018 to May 2018. A total of 147 students from the second professional year were told to fill a questionnaire consisting of their age, gender, class, washing of hands with soap and water before eating food, washing with soap and water after urinating, washing with soap and water after defecating, washing hands after using the practical laboratory, the reason for the disinfection of the body, and the number of illnesses in the past one year. Results: Analysis of the outcome demonstrated that the medical students studied were careful about the average towards hand hygiene and on an overall note have come to embrace the importance of hand hygiene stressing on the numerous adverse effects its lack of practice have come to prove over the years. Conclusion: A connection between hand cleanliness, sickness rate, and explanations behind not rehearsing hand cleanliness appears in the outcomes. The current examination proposes that both handwashing and the utilization of hand sanitizers have a beneficial outcome on the health of medical students. The results of improved hand cleanliness propensities for the students bring about diminished medical services costs for the college since fewer students may need to use well-being focus assets.
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Evaluation of corticosteroid use pattern and their adverse effects in patients visiting the dermatology department of a tertiary care teaching hospital in Warangal, India p. 60
Gogula Archana Reddy, Samreen Ayesha, Masood Ali Sheema, Bandaru Sheshagiri Sharvana Bhava, Valupadas Chandrashekar, Eggadi Venkateshwarlu
Introduction: Corticosteroids have become a mainstay of pharmacotherapy in dermatology because of their anti-inflammatory and immunosuppressive properties. However, misuse and sudden cessation of these drugs may render a patient to develop numerous adverse effects (AEs). Adverse drug reactions (ADRs) are important causes of mortality in both hospitalized and ambulatory patients. Early detection, evaluation, and monitoring of ADRs are essential to reduce harm to patients. Therefore, to achieve optimum benefit with the least AEs, safe and effective use of these agents is very crucial. Objective: To examine the corticosteroid use pattern, to assess the frequency of misuse and the associated AEs that are encountered in dermatological practice. Materials and Methods: A prospective observational study was conducted in the dermatology department of a tertiary care teaching hospital, Warangal for a period of six months. All patients using at least one corticosteroid either topically or systemically were included in the study. Informed consent was taken from patients. Results: A total of 151 participants were included in the study. Among them, 56% of females developed ADRs compared with males (44%). Among patients using topical corticosteroids (TCs), the most frequently reported ADRs include facial erythema (7.31%), acne (17.07%), and hyperpigmentation of the face (2.43%). The AEs associated with oral corticosteroids include weight gain (19.51%) and taenia corporis (19.5%). Conclusion: Corticosteroids have extreme importance in dermatological practice. However, inappropriate and prolonged users render a patient to develop several AEs. Precise drug regimens and proper patient counseling can help in minimizing and managing the AEs associated with inappropriate use.
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National Accreditation Board for Hospitals and Healthcare Accreditation System for healthcare sector in India: An overview p. 66
Anand G Bodade, Ragini G Bodade
Quality and standards of services in healthcare have become essential for the current generation of healthcare providers and beneficiaries, that is, patients. Healthcare accreditation has become the most important tool for improving the standard of the hospitals and thereafter benchmarking. Most hospitals and healthcare providers are differentiated and evaluated according to their organizational performance and quality. National Accreditation Board for Hospitals and Healthcare Providers (NABH) is an integral board of the Quality Council of India (QCI), which has been established to operate an accreditation program for healthcare organizations/institutions globally. Accreditation is a public recognition awarded to healthcare organizations that fulfill the standards laid by NABH through an independent external assessment, conducted by a qualified team of assessors. In India, healthcare organizations face a lot of burden on the number of patients. However, it is important to have a keen quality and standards of services to such a huge number of patients without compromise. NABH helps with its standards controlling the standard of care and services by the health industry in different areas. There is a constant need that many such organizations are motivated to undergo an accreditation process to have uniformity in the standard of services worldwide as it is a voluntary act in India.
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Novel active pharmaceutical ingredients from India: The actors-Part-I p. 73
Prasanta Kumar Ghosh
Sixteen novel active pharmaceutical ingredients, namely Urea stibamine, Methaqualone, Enfenamic acid, Hamycin, Centimizole, Centbutindole, Ormiloxifene, Centpropazine, Centbucridine, Alpha-beta-arteether, Bulaquine, Chandonium Iodide, Sintamil, Amoscanate, Saroglitizar, and Diperoxochloric Acid (DPOCL), were discovered from India. Six formulations, namely of Ormiloxifene, Alpha-beta-arteether, Bulaquine, Sintamil, Saroglitizar, and DPOCL, are in the market. The Indian pharmaceutical industry uses nearly 2200 active pharmaceutical ingredients (APIs) for the manufacture of nearly 60,000 branded generic and generic formulations from its nearly 3000 manufacturing units. The industry manufactures nearly 1000 APIs locally and imports about another 1200 APIs; the manufacture of generic APIs as well as formulations is heavily dependent on imports. To remain a dominant manufacturer, India needs to invest in the discovery of novel APIs.
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Segmental Darier’s disease, a rare disorder of keratinization: a case report p. 83
Abeer M Ilyas, Ujwala Maheswari
We present a case of Darier disease which is a rare autosomal-dominant genodermatosis. It is clinically manifested by hyperkeratotic papules primarily affecting seborrheic areas. A 30-year-old male came with complaints of papules that were restricted to the lateral aspect of the trunk on the right side and right underarm area. Histopathological examination showed the acanthosis of the epidermis with premature keratosis and suprabasal acantholysis. Darier’s disease must be distinguished histologically from other acantholytic dyskeratoses. It has been observed that biopsy is fundamental to make the final diagnosis. However, a multidisciplinary approach is required to treat affected patients.
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The Effectiveness of machine learning in suicide prediction and prevention p. 86
Chidiebere Emmanuel Okechukwu
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Strengthening the component of online assessments in medical education p. 88
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
The emergence of coronavirus disease-2019 has accounted for major disruptions of all sectors, including medical education. As there was no clarity about the re-opening of medical institutions, we shifted from the conventional model to an online form of teaching-learning and assessment. The online assessments can be carried out in different ways and have been associated with a wide range of benefits for the teachers and the students. The online assessments tend to have multiple concerns as well, which are predominantly linked to the involved financial costs, internet issues, assessment of all the domains of learning, etc. Most of the above challenges in online assessments can be handled effectively by sustained administrative support, initial financial investment to establish the system, and the appointment of a qualified technical team to operate the system in the institution. In conclusion, online assessments among medical students have to be carried out to assess the progression of learning. The need of the hour is to overcome the prevailing challenges and strengthen the overall process of teaching-learning by addressing them better through administrative and technical support.
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Irritant contact dermatitis to quarantine stamps p. 90
Rashi Satyanarayan Soni, Shylaja Someshwar
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