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   Table of Contents - Current issue
Coverpage
January-March 2019
Volume 8 | Issue 1
Page Nos. 1-76

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REVIEW ARTICLE  

Molecular mediators, characterization of signaling pathways with descriptions of cellular distinctions in pathophysiology of cardiac hypertrophy and molecular changes underlying a transition to heart failure Highly accessed article p. 1
Leta Shiferaw Melaku, Tewodros Desalegn
DOI:10.4103/ijhas.IJHAS_104_17  
The heart is composed of cardiac myocytes, nonmyocytes, and surrounding extracellular matrix. Cardiac hypertrophy (CH) is molecular, cellular, and interstitial changes that manifest clinically as changes in size, shape, and function of the heart in a response to mechanical and neurohormonal stimuli. CH is recognized as an adaptive process to a variety of physiological and pathological conditions. Although adult-onset hypertrophy can ultimately lead to disease, CH is not necessarily maladaptive and can even be beneficial. It enables myocytes to increase their work output, which improves cardiac pump function. The pathophysiology of CH is complex and multifactorial, as it touches on several cellular and molecular systems. Numerous mediators have been found to be involved in its pathogenesis that includes mitogen-activated protein kinases, protein kinase C, insulin-like growth factor-1, phosphoinositide 3-kinase-Akt/protein kinase B, calcineurin-nuclear factor of activated T cell, and mammalian target of rapamycin. CH is usually considered a poor prognostic sign and is associated with nearly all forms of heart failure. Understanding the molecular background of CH is essential to slow down the destined progression to heart failure. CH has been considered as an important risk factor for cardiac morbidity and mortality whose prevalence has increased during the past few decades. This knowledge will allow the identification of novel molecular targets for pharmacological intervention and will assist the future development of therapeutic strategies for managing cardiovascular disorders. This brief review will give a general overview of basic morphology of heart, various molecular signal transduction pathways, the regulators of CH, and molecular changes underlying a transition to heart failure.
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MINI REVIEW Top

How milk banks can help bereaved mothers p. 25
SN Prakrithi, Suhas Chandran, M Kishor
DOI:10.4103/ijhas.IJHAS_92_18  
The process of lactation continues to occur irrespective of the survival of the child, through hormonal cascades triggered over the course of physiological changes of pregnancy. This leads to a difficult predicament in bereaved mothers, where loss, grief as well as lactation have to be dealt with in addition to enduring the physical pain of childbirth. In these cases, lactation is hardly addressed during the pre- or postnatal period, leading to a significant amount of distress in the mother. Guidance regarding options of suppression, expression, and donation of breast milk along with knowledge and easy accessibility to human milk banks which specifically cater to bereaved mothers can be provided, so as to alleviate confusion and aid in informed decision-making. This paper highlights the psychological benefits of lactation in the grieving mother, which include downregulation of stress response, shortening of the grieving period, improved self-efficacy, and risk reduction for mood disorders during the postpartum period in prospective donors. It emphasizes the need for expansion of the human milk bank network to offer larger coverage and also suggests potential interventions to enhance awareness about milk banking in health-care professionals as well as the general public, ultimately leading to positive outcomes in both high-risk infants and mothers with infant loss, which are major health concerns in India and need pressing attention.
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ORIGINAL ARTICLES Top

Role of Betadine irrigation in chronic suppurative otitis media: Our experiences in a tertiary care teaching hospital of East India p. 29
Santosh Kumar Swain, Ishwar Chandra Behera, Mahesh Chandra Sahu
DOI:10.4103/ijhas.IJHAS_13_18  
BACKGROUND: Chronic suppurative otitis media (CSOM) is persistent and insidious disease of the middle ear cleft characterized by otorrhea, permanent perforation of the tympanic membrane, and hearing loss. It is one of the most common bacterial infections in otolaryngology. OBJECTIVE: The objective is to find out an appropriate medical treatment for CSOM patients. The effect of diluted Betadine irrigation along with systemic antibiotic in CSOM and consider the most appropriate medical treatment.. MATERIALS AND METHODS: This study was a prospective study and done from 2015 to 2017 in patients with tubotympanic type of CSOM where 600 such patients were participated in this study and randomly divided into two groups. One group was treated with diluted povidone Betadine aural toileting whereas another group only with topical and systemic antibiotics. RESULTS: In Group A, otorrhea resolution was seen in 86%, and healing of the perforation was noted in 28% cases in the group treated with regular aural Betadine toileting. In Group B, those were treated with only topical and systemic antibiotic, 65% of the patients show otorrhea resolution, and 15% achieved healing of the perforation. CONCLUSION: Aural toileting and irrigation with diluted Betadine are a desirable and well accepted compared to topical and oral antibiotics.
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Pelvic ultrasonographic findings in patients with acute right iliac fossa pain p. 33
Moawada Burai, Moawia Bushra Gameraddin, Ali Suliman, Awadia Gareeballah, Fathelrehman Alagab, Maisa Elzaki
DOI:10.4103/ijhas.IJHAS_6_18  
BACKGROUND: Pain in the right iliac fossa (RIF) is considered the most common presentation of the patients in the emergency department (ED). OBJECTIVE: The objective of this study was to assess various etiologies of acute pain in the RIF using ultrasonography. MATERIALS AND METHODS: This was a cross-sectional study conducted in Khartoum North Teaching Hospital and Alrebat University Hospital from January 2016 to July 2016. A total of 100 patients presented to the ED with acute pain in the RIF. The patients were investigated with ultrasound (US) using 3.5- and 5-MHz transducers. The exclusion criteria included chronic illness, known cancer, and women in late pregnancy. RESULTS: A total of 100 cases who presented with pain in the RIF had been examined clinically and sonographically. A number of 26 cases (26%) showed no findings, whereas 19% were with appendicitis, ovarian cysts represented 17%, right lower ureteric stone represented 16%, and pelvic inflammatory disease represented 12%. Gender and age were the significant factors affecting the distribution of diseases that cause pain in the RIF (P = 0.04). CONCLUSION: In addition to appendicitis, there were a variety of abnormalities that cause pain in the RIF. Ovarian cysts and lower ureteric stone were the most etiologies of pain in the RIF following appendicitis. US of the pelvis is essential before proceeding with any surgery for acute pain in the RIF, especially in young women.
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Temporomandibular joint dysfunction in adults: Its relation to pain, general joint hypermobility, and head posture p. 38
Ahmet Cuneyt Akgol, Tulay Cevik Saldiran, Lacin Naz Tascilar, Begum Okudan, Gamze Aydin, Derya Azim Rezaei
DOI:10.4103/ijhas.IJHAS_90_18  
BACKGROUND: The first objective is the questioning of the presence of general joint hypermobility (GJH) and temporomandibular joint dysfunction (TMJD) in adults and examining the existence of the relationship between GJH and TMJD. The secondary purpose of this study questions whether there is a relationship between the forward head posture and GJH. MATERIALS AND METHODS: GJH assessments were carried out with the Beighton Hypermobility Score. Participants were assessed by a plumb line for postural assessment. During mouth opening, the examination of temporomandibular joint (TMJ) was evaluated based on if the mandible shows deflection or deviation. Pain assessment in TMJ was evaluated through three different pain areas, during rest and chewing activity and at night with the visual analog scale. Masseter muscle pressure sensitivity was recorded by measuring it with a dolorimeter. RESULTS: There was a positive correlation between hypermobility status and temporalis muscle pain at night (r: 0.218, P < 0.005). It was observed that those who are not hypermobile had more pain caused by chewing activity in masseter muscle than hypermobile participants (P < 0.005). CONCLUSION: In the presence of GJH, in order to maintain rehabilitation in the most effective way and to anticipate the secondary problems that may occur, the TMJ should be thoroughly examined for pain, sensitivity, and functionality.
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Perinatal asphyxia in term neonates seen in Federal Medical Centre, Birnin Kudu, Nigeria p. 44
Umma Abdullahi Idris
DOI:10.4103/ijhas.IJHAS_11_18  
BACKGROUND: The World Health Organization estimates that 4 million children are born with asphyxia every year, of which 1 million die and an equal number survive with severe neurologic squeal. Majority of cases are in sub-Saharan Africa. This study aimed at determining the prevalence, associated factors, and hospital outcome of term neonates hospitalized for perinatal asphyxia. METHODOLOGY: This was a descriptive cross-sectional observational study of term neonates with low Apgar scores and outborn babies with no Apgar score but with features of asphyxia admitted over a period of 12 months into the Special Care Baby Unit of the Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria. Case files of the patients were retrieved, and relevant information was obtained. RESULTS: Forty-nine of 212 babies admitted had perinatal asphyxia giving a prevalence of 23.1%. Majority of the babies were males and presented within the first 12 h of life with a mean birth weight of 2.66 ± 0.52 kg. Most of the mothers of the asphyxiated babies were primiparous and booked and had prolonged obstructed labor. Thirty-six (73.4%) of the babies were discharged home, eight (16.3%) left against medical advice, and five died to give the case fatality rate of 10.3%. CONCLUSION: Perinatal asphyxia is a common cause of neonatal morbidity. It was common among babies delivered through emergency cesarean section whose mothers are primiparous and had prolonged labor and/or eclampsia.
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Analysis of facial and deep neck space infections in patients with comorbidities p. 48
Arthur Nwashindi
DOI:10.4103/ijhas.IJHAS_40_17  
OBJECTIVE: The objective of this study was to analyze a series of patients with facial space infection associated with comorbidities. MATERIALS AND METHODS: Data were collated from 98 patients with facial and deep neck space infections who met the inclusion criteria over a period of 3 years. Data included demographic information, anatomic space involved, and comorbid factors. RESULTS: A total of 98 patients who met the inclusion criteria were investigated in this study. Majority of the patients were within the age group of 46–55 (36.73%) years, whereas the least affected age group was 16–25 years (3.06%). Females were more involved while the spaces involved with Ludwig angina had the highest frequency. Diabetes mellitus (DM) was the highest comorbid factor. The patients presented mostly within 24–48 h from the onset of infection. CONCLUSIONS: Facial and deep neck space infections occur due to spread of infection within the spaces. DM and HIV infections are the most common comorbid factors.
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Hematological features in malarial infection and their variations with parasite density: A retrospective analysis of 6-year data in an Indian city p. 53
Prabu Anandhan Motchan, Priya Subashchandrabose, Madhu Basavegowda, Anita Suryanarayan
DOI:10.4103/ijhas.IJHAS_57_18  
BACKGROUND: Considering that physicians routinely perform complete blood counts (CBCs) for patients with fever in India, it is useful in comparing these counts across malaria positive and negative cases, as well as the variation of these features with parasite density. OBJECTIVES: This study aims to compare hematological characteristics in malarial positive and negative patients, compare parasite density with hematological characteristics, estimate sensitivity and specificity of hematological characteristics as indicators of malarial infection, and compare platelet distribution width (PDW) and plateletcrit (PCT) in positive cases with negative cases. MATERIALS AND METHODS: We performed a retrospective analysis of 6-year data in a pathology laboratory to compare CBC of malaria-positive (n = 299) versus malaria-negative blood (n = 287) samples. PDW and PCT tests were available for some samples (n = 100) for a subanalysis. Parasite density, determined by scoring (1+ to 4+) in quantitative buffy coat-malarial parasite detected cases (n = 279), was compared with hematological features. RESULTS: The hematology of malarial infection was characterized by bicytopenia or pancytopenia (P < 0.001, odds ratio [OR] = 11.14) of which thrombocytopenia was the most prominent component (P < 0.001, OR = 37.94), followed by anemia due to reduction in red blood cell (RBC) count effecting a decrease in packed cell volume (PCV) (P < 0.003, OR = 2.13) with an elevated red cell distribution width (P < 0.025, OR = 1.78). Higher parasite density was associated with increased incidence of anemia and severe thrombocytopenia. PDW was elevated (P < 0.001, OR = 6.93) and PCT was reduced (P < 0.001, OR = 123.64) in positive cases. CONCLUSIONS: Thrombocytopenia with reduction in PCV or reduced RBC count is a distinguishing feature of malaria.
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Low bone mineral density and its risk factors in an urban adult population of South India p. 61
Pawan Kumar Sharma, Shravani Sriram, Anantha Krishna, Atul Gandhi, Enakshi Ganguly
DOI:10.4103/ijhas.IJHAS_36_18  
BACKGROUND AND OBJECTIVES: Low bone mineral density (BMD) is widely prevalent in Indian populations. Very few studies that reported risk factors for low BMD and osteoporosis did not explore its relationship with age and sex. Objectives were to determine the prevalence of low BMD and osteoporosis in urban adults, and study the age- and sex-wise trends of changing BMD. METHODOLOGY: BMD of 521 healthy adults aged 20 years or more was tested using quantitative ultrasound of right tibia, and T-scores thus obtained indicated normal or low BMD. Multivariate analysis was done to calculate odds ratios for risk factors for low BMD and osteoporosis. RESULTS: Eighty-four percent participants had low BMD. Low BMD increased significantly with increasing age in both genders. An increase in age per standard deviation (SD) was associated with four-fold increase in risk of low BMD for both women (odds ratio [OR]: 4.83, 95% confidence interval [CI]: 2.61–8.92) and men (OR: 4.14, 95% CI: 2.44–7.05). Age per SD (OR: 2.28, 95% CI: 1.37–3.81) and age–gender interaction (OR: 1.09, 95% CI: 1.02-1.17) was positively associated with osteoporosis. Increasing age by one SD was associated with seven-fold increase (OR: 7.35, 95% CI: 3.51–15.40) in risk of osteoporosis among women. CONCLUSIONS: Low BMD is highly prevalent in South Indian urban population. Low BMD and osteoporosis were positively associated with increasing age. Loss of BMD appeared to begin at young ages thereby indicating the need for early institution of prevention measures.
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Dentist's knowledge regarding oral mucosal lesions: Revealing the diagnostic dilemma p. 68
Anuraag Choudhary, Ajinkya Deshmukh, Mayur Chaudhary, Shweta Chaudhary, Atul Deshmukh, Trupti Chaudhary
DOI:10.4103/ijhas.IJHAS_29_18  
BACKGROUND: The management of oral mucosal disease necessitates establishing the correct diagnosis from a range of presenting lesions. Practitioners have to possess adequate knowledge about the likely differential diagnosis. Many studies suggest that general practitioners (dentists) fail to detect oral mucosal lesions (OMLs), especially oral precancerous lesion as well as early oral cancer because of their indifferent attitude and knowledge about these lesions.[1],[2],[3],[4],[5],[6],[7],[8],[9] Few studies have investigated the knowledge and opinions of general dental practitioners and specialists other than oral surgeon and medics about OML including oral cancer, as these personnel come across such lesions more frequently as often in their outpatient department and thereby know the planned management of these lesions. METHOD: The present study aims to identify, compare, and analyze the knowledge and opinions of dentist regarding OML and evaluate the differences between the attitudes of dentist by practice settings in Pune city, by using questionnaire method.[2] RESULT: most of the dentist found difficulty in diagnosing oral mucosal lesions which are the manifestations of systemic diseases. CONCLUSION: Here we concluded that most of the dentist found difficulty in diagnosing the oral mucosal lesion. Professional dental education programs and courses can help them to enhance their knowledge, skill and ability in diagnosing the various oral mucosal lesions.
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LETTERS TO EDITOR Top

Anesthetic dilemma in a case of tuberculoid leprosy p. 73
Deepak Dwivedi, Vidhu Bhatnagar, Abhijit A Karmarkar, M Kanagraj
DOI:10.4103/ijhas.IJHAS_95_18  
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Worldwide implementation of the global roadmap to end cholera by 2030 p. 75
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/ijhas.IJHAS_134_17  
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