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   Table of Contents - Current issue
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October-December 2018
Volume 7 | Issue 4
Page Nos. 213-275

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ORIGINAL ARTICLES  

A study on microbiological profile and risk factors of breast abscess cases attending a tertiary care hospital in Kolkata p. 213
Simit Kumar, Maitreyi Bandyopadhyay, Arani Debnandi, Abhishek Sengupta, Manas Kumar Bandyopadhyay, Prabir Kumar Mukhopadhyay, Mitali Chatterjee
DOI:10.4103/ijhas.IJHAS_150_17  
INTRODUCTION: Primary breast abscesses occur both in the puerperal and nonpuerperal settings and affect women of all ages. Breast abscesses are a common complication of the postpartum period afflicting 9%–33% of all lactating women. Incision and drainage with postoperative antibiotic drugs has been suggested as the treatment of choice but data regarding the bacteriological profile and antibiotic susceptibility is lacking. AIMS AND OBJECTIVES: To find out the risk factors, bacteriological profile along with antibiotic susceptibility pattern of breast abscess cases. MATERIALS AND METHODS: A total of 136 breast abscess cases were studied over a period of 1 year to identify the risk factors and to isolate the organisms. RESULTS: Among 136 cases 88 (64.7%) were suffering from puerperal breast abscess whereas 48 (35.3%) patients suffered from nonpuerperal breast abscess. Staphylococcus aureus was the predominant pathogen, of which 57.35% showed methicillin resistance. Young age, primiparous, difficulty in lactation came out to be the most important risk factors for development of puerperal breast abscess whereas diabetes mellitus was the predominant risk factor for nonpuerperal breast abscess. DISCUSSION: This is the first study from India in recent past to evaluate the susceptibility patterns of bacterial isolates from breast abscesses as well as risk factors for development of breast abscesses which highlights probably the emergence of community-acquired methicillin-resistant S. aureus as a predominant pathogen of breast abscess cases.
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Stroke upper extremity rehabilitation: Effect of bilateral arm training Highly accessed article p. 217
Damayanti Sethy, Surjeet Sahoo, Eva S Kujur, Pankaj Bajpai
DOI:10.4103/ijhas.IJHAS_125_17  
OBJECTIVES: The main objective of this study is to investigate the effect of bilateral arm training on upper extremity motor and functional recovery in stroke hemiparesis. METHODOLOGY: Twenty-eight patients with chronic stroke, attending the Department of Occupational Therapy, National Institute for the locomotor disabilities, Kolkata, West Bengal, India, participated in a single-blinded randomized pretest and posttest control group experimental study. Patients were randomized over two intervention groups; experimental group received bilateral arm training (n = 14) and the control group received an equally intensive conventional treatment program (n = 14). Each group received intensive training for 1 h/day, 5 days/week, and for 6 weeks. Pretreatment and posttreatment measurements were taken for upper extremity motor ability, functional ability, and functional use of the upper extremity using Fugl-Meyer Assessment of Physical performance (FMA-upper extremity section), Action Research Arm Test, and Motor Activity Log, respectively. RESULTS: Bilateral arm training (P = 0.01) group showed statistically significant improvement in upper extremity functioning on Action Research Arm Test score in comparison to the conventional therapy group (P = 0.33). The bilateral arm training group also had greater improvements in FMA and Motor Activity Log score compared to conventional therapy group. CONCLUSION: Bilateral arm training can be used as a better treatment choice for improving upper extremity function in comparison to conventional therapy.
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A study on polypharmacy and drug interactions among elderly hypertensive patients admitted in a tertiary care hospital p. 222
Rajat Kumar Agrawal, Shailesh Nagpure
DOI:10.4103/ijhas.IJHAS_152_17  
BACKGROUND: Polypharmacy may be defined as the effects of taking multiple medications concurrently to manage coexisting health problems, such as diabetes and hypertension. Polypharmacy is an important issue in elderly patients. METHODS: A cross-sectional study was conducted in the rural tertiary care teaching hospital in Central India over 2 months. A total of 100 patients were studied. The study population included hypertensive geriatric population above 65 years admitted in the medicine ward who were willing to consent for participation. The patients with incomplete case sheets admitted in the Emergency and Intensive Care Units and with serious illness, malignancy, and other complications were excluded. RESULTS: Out of the total 403 medicine prescribed to study population, 271 potential drug–drug interactions were observed among elderly hypertensive patients. Moderate drug–drug interaction was found to be most common (50.62%) followed by mild (8.64%) and severe (7.94%). Most common potential inappropriate medicine used was spironolactone followed by diltiazem, diclofenac, olanzapine, metoclopramide, digoxin, insulin, and isopto hyoscine (Sliding scale) in the study population. CONCLUSION: In the present study, we can conclude that polypharmacy is a major risk factor for secondary morbidity in elderly patients. Polypharmacy leads to more potential drug–drug interactions and potential inappropriate medicine use. The use of medicines to disease condition is necessary, but unnecessary load of drugs to patient will increase the safety problems. Polypharmacy can be avoided by sharing treatment goals and plans. To improve drug safety in this high-risk population, appropriate prescribing might be more important than simply reducing the number of prescribed drugs.
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Effect of goal-oriented mobility training on capacity and performance qualifier of International Classification of Functioning, Disability, and Health in children with cerebral palsy: A Pilot study p. 228
Chetana Ashok Kunde, Suvarna Shyam Ganvir
DOI:10.4103/ijhas.IJHAS_93_17  
BACKGROUND: Mobility is the ability to move freely and is essential for social activities and participation. Cerebral palsy (CP) is the disorder of movement and posture. These impairments cause limitations in the capacities of the affected child. The purpose of this study is to examine the effect of goal-oriented mobility training on functional mobility scale (FMS), gross motor function measure (GMFM), and capacity and performance qualifier of International Classification of Functioning, Disability, and Health (ICF), and the secondary objective was to study the association between GMFM and capacity qualifier of ICF also FMS and performance qualifier of ICF. MATERIALS AND METHODS: Ten children with CP (5–10 years) were included in the study after institutional ethics committee approval clearance. Children with gross motor function classification system level II, III, and IV was included in the study. Based on the inclusion and exclusion criteria, children were selected for the study. Capacity was measured using GMFM at three items (44, 67, and 70). Performance was analyzed using FMS. Capacity and performance were measured at (d460, d465) domain of ICF. Goal-oriented mobility training was given for 1 h/day for 6 days/week for 6 months to improve mobility. RESULTS: Pearson's correlation analysis shows a moderate negative correlation between GMFM (67, 70) and capacity qualifier of ICF (r = −0.7, 70; r = −0.7) and strong negative correlations between FMS (5 m) and performance qualifier of ICF (r = −0.9). After mobility training, a significant difference was noticed at FMS (5 m, P = 0.001), GMFM (67, P = 0.015), and ICF (d460 = 0.007, 0.002; d465 = 0.007, 0.007) CONCLUSION: A moderate negative correlation exists between GMFM (67, 70) and capacity qualifier and a strong negative correlation between FMS (5 m) and performance qualifier of ICF. Six-month mobility training could improve capacity and performance of children to walk with assistance in home environment compared to school and community setting.
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Pattern of morbidity and depression among the urban geriatric population: A community-based survey in Bhubaneswar, Orissa, India p. 233
Tanjib Hassan Mullick, Sumana Samanta, Baisakhi Maji, Lisa Sarangi
DOI:10.4103/ijhas.IJHAS_56_18  
BACKGROUND: Current global and national demographic structures are shifting toward a higher proportion of the elderly population. More than 50% of the population aged above 70 years of age suffers from one or more chronic conditions. Depression is the most frequent psychiatric disorder in the elderly population. OBJECTIVES: The objective of this study was to assess the pattern of morbidity and depression among the elderly people as well as to identify the determinants of depression. MATERIALS AND METHODS: A community-based cross-sectional study was undertaken from September 2014 to June 2015 in the urban field practice area of Hi-Tech Medical College, Bhubaneswar. The simple random sampling was performed to select 450 geriatric people. House-to-house visit was done to interview the participants with a predesigned pretested schedule. The schedule contained baseline characteristics, morbidity questions, Katz activity of daily living (ADL) scale, and geriatric depression scale. Collected data were entered into MS Excel spreadsheet and analyzed with the help of SPSS 22.0 version. RESULTS: Major morbid condition was concerned with Cardio Vascular System (31.7%), followed by cataract and musculoskeletal system. Among the study population, 45.8% had no depression, 15.1% had mild depression, 30.7% had moderate depression, and 8.4% had severe depression. Age, marital status, education, financial dependency, Katz ADL, and chronic diseases were significantly associated with geriatric depression. CONCLUSION: Recreational activities, awareness generation regarding regular exercise, strengthening of social security systems, arrangement of old age homes, legal measures to take care of the elderly, promotion of self-help group, and proper counseling are the measures to be taken to combat geriatric depression at this hour.
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Ameloblastoma: Clinicopathologic and therapeutic analysis of 67 cases seen at Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria p. 240
Adebayo Aremu Ibikunle, Abdurazzaq Olanrewaju Taiwo, Ramat Oyebunmi Braimah, Michael Adeyemi, K Abdullahi, Saddiku Mohammad Sahabi
DOI:10.4103/ijhas.IJHAS_39_18  
INTRODUCTION: Ameloblastoma is a benign odontogenic neoplasm which is slow growing, locally aggressive, and has a potential for recurrence. Recurrence rates as high as 75% have been reported. If unattended to, it results in large grotesque maxillofacial growths with consequent impairment of function and esthetics. This study aims to report the clinicopathologic and surgical outcome of patients managed on account of ameloblastoma at a Nigerian teaching hospital. MATERIALS AND METHODS: Records of patients histologically diagnosed with ameloblastoma of the jaws between March 2010 and March 2017 at Usmanu Danfodiyo University Teaching Hospital were retrieved. Information on biodata, clinic-pathologic features, treatment modality, mode of reconstruction, postsurgical follow-up period, and recurrence was obtained. RESULTS: A total of 67 patients were included in this study, including 41 (61.2%) males and 26 (38.8%) females; with a mean age (± standard deviation) of 31.43 (±13.65) years. The modal decade of presentation was the third decade of life. Majority of the tumors were right sided 27 (40.3%). Fifty-six (83.6%) of the cases were seen in the mandible, while 11 (16.4%) occurred in the maxilla. Majority of the tumors were multilocular 62 (92.5%). All the unilocular radiolucencies were seen among patients younger than 23 years of age. The most frequently observed histological subtype was the follicular type 26 (38.8%); rare mixed lesions were also seen. Immediate reconstruction was performed in most of the patients. Recurrence was observed in 1 case (1.5%). CONCLUSION: Ameloblastoma remains a prominent health challenge in our climes. Patients often present late resulting in large maxillofacial tumors that are challenging to manage.
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Baroda development screening test for infants in a perinatal psychiatry setting: A preliminary report from India p. 246
M Thomas Kishore, Geetha Desai, Poornima Mahindru, G Ragesh, Harish Thippeswamy, Sundarnag Ganjekar, Prabha S Chandra
DOI:10.4103/ijhas.IJHAS_82_17  
BACKGROUND: There is a need for early and reliable screening methods to identify the developmental delays in infants born to mothers with perinatal psychiatric disorders. Developmental assessment scales for Indian infants (DASII) is the only standardized tool from India for use in infants but is time-consuming and expensive, which may not be useful in busy outpatient settings or when the mother has a psychiatric illness. AIM: To examine the correlation between the Baroda development screening test (BDST), developmental screening test (DST), and DASII full scale (i.e., both motor and mental scales). METHODS: The study included thirty consecutive infants in the age range of 1–6 months from inpatient and outpatient perinatal psychiatric services. The infants were screened with DST and BDST and later assessed with DASII full scale. RESULTS: Both BDST and DST showed significant correlation with mental subscale and motor subscale of DASII, but only BDST predicted the DASII scores on mental scale (standard error [SE] = 0.14; t = 0.73; P < 0.01) and the motor scale (SE = 0.12; t = 0.73; P < 0.01). CONCLUSIONS AND IMPLICATIONS: Both DST and BDST show good correlation with DASII, but only BDST predicts the DASII scores. The findings need to be replicated with larger sample size and different settings to establish BDST as an effective screening tool in identifying developmental delays in infants born to mothers with perinatal psychiatric disorders.
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Prevalence of New Delhi metallo-β-lactamase-1 in Pseudomonas aeruginosa and its antimicrobial resistance profile in hospitalized patients in a tertiary care hospital setup p. 250
Anjali Agarwal, Sneha Mohan, Ujjwal Maheshwari, Sambhav Jain, Suresh Lacchhman Akulwar
DOI:10.4103/ijhas.IJHAS_163_17  
BACKGROUND: Pseudomonas aeruginosa is one of the most common causes of nosocomial infections. Carbapenems are widely used for the treatment of this microorganism, but nowadays, increasing number of carbapenem-resistant P. aeruginosa (CRPA) isolates are increasing which further lead to treatment failure due to associated multidrug resistance. AIM: The present study was done to determine the prevalence of New Delhi metallo-β-lactamase-1 (bla NDM-1) in P. aeruginosa in hospitalized patients in a tertiary care setup. SETTINGS AND DESIGN: The study was conducted in the department of microbiology with the tertiary care hospital settings. It was a prospective cross-sectional observational study conducted from June 2014 to December 2014. MATERIALS AND METHODS: Antibiotic susceptibility test was performed using Kirby–Bauer disc diffusion method for screening of the isolates. P. aeruginosa isolates with the zone diameter of carbapenems ≤18 mm were considered as carbapenemase producers. Metallo-beta-lactamases (MBL) detection was done using imipenem- ethylenediaminetetraacetic acid double-disc synergy test. NDM-1 gene in P. aeruginosa was identified using conventional polymerase chain reaction. STATISTICAL ANALYSIS USED: Chi-square test was used to analyze the data and P < 0.01 was considered statistically significant. RESULTS: Out of 460 P. aeruginosa, 74 (16.08%) isolates were CRPA. A total of 61 (13.2%) MBL-producing P. aeruginosa were isolated, and bla NDM-1 gene was detected in 18 (3.91%) P. aeruginosa isolates. CONCLUSION: The study showed increasing multidrug resistance among CRPA compared to carbapenem-sensitive P. aeruginosa. It also determined increasing prevalence of bla NDM-1 in P. aeruginosa isolates. It is emphasized to timely identify these pathogens and treat with proper antibiotics to reduce morbidity and mortality.
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Induction of G2/M cell cycle arrest and phosphorylated-extracellular signal-regulated protein kinase 1 and 2-induced caspase 3/7-independent apoptosis in HT-29 cells by the combination of fraction S1 and citrinin from Penicillium strain H9318 p. 256
Suek Chin Ooi, Heng Fong Seow
DOI:10.4103/ijhas.IJHAS_138_17  
OBJECTIVES: To determine the effect of potential anticancer property of secondary metabolites of Penicillium strain H9318. MATERIALS AND METHODS: Cytotoxicity of HT-29 cells was accessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide viability assay to give a preliminary comparison of the efficacy of fraction S1 and citrinin H9318. Mode of action of the combination treatment of fraction S1 and citrinin H9318 was determined by the cell cycle assay using propidium iodide-staining method performed with a flow cytometer. Further clarification of the anticancer mechanism of the combination treatment was carried out by the assays of pan-caspase, caspase-3/7, and western blot to examine the apoptosis of HT-29 cells. RESULTS: HT-29 cells show dose-dependent manner in cytotoxicity. HT-29 cells were arrested at G2/M phase with decrease in phosphorylated-retinoblastoma protein. Citrinin H9318, citrinin H9318 and fraction S1 combination-treated HT-29 cells show induction of pan-caspase. Caspase-3/7 was found decrease in the combination of citrinin H9318 and fraction S1 through up-regulation of phosphorylated-extracellular signal-regulated protein kinase 1 and 2 (p-ERK1/2). CONCLUSION: Citrinin H9318 alone did not reduce activity of caspase-3/7 significantly in the apoptosis of HT-29 cells. The combination treatment of fraction S1 and citrinin H9318 contributed to apoptosis via up-regulation of p-ERK1/2 with reduced activity of caspase-3/7.
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CASE REPORTS Top

Disulfiram-induced hyperpigmentation p. 263
MC Gupta, Kartik Nayak, Savita Verma, Siddharth Arya
DOI:10.4103/ijhas.IJHAS_44_18  
Abnormal pigmentation of skin is a less morbid condition but can be more distressing to the patient and a major cause of psychological distress. Disulfiram is the first-line drug for the treatment of alcohol dependence. It inhibits acetaldehyde dehydrogenase resulting in accumulation of aldehyde component of ethanol metabolism leading to unpleasant effects. Disulfiram-induced dermatological disorders correspond to an intermediate rate of adverse reactions, and occurrence of hyperpigmentation is a very rare phenomenon. In this submission, we report a case of disulfiram-induced hyperpigmentation in a patient being treated for alcohol dependence.
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Dysplastic cerebellar gangliocytoma (Lhermitte–Duclos disease) in the immediate postpartum period p. 266
Prashant S Gade, Harish R Naik, Laxmikant Bhople, Vernon Velho
DOI:10.4103/ijhas.IJHAS_16_18  
Lhermitte–Duclos disease, also known as dysplastic cerebellar gangliocytoma, is a rare lesion of the cerebellar cortex with both neoplastic and hamartomatous features. A “tiger-striped” cerebellar lesion with unilateral hemispheric expansion and preservation of the gyral pattern is a characteristic finding on magnetic resonance imaging brain. It usually occurs in the setting of Cowden's syndrome, an autosomal dominant condition characterized by multiple hamartomas and neoplastic lesions in skin and internal organs. Evolution of dysplastic cerebellar gangliocytoma during pregnancy is not well known, given its rarity. We describe a young female who presented in the immediate postpartum period with acute hydrocephalus secondary to the left cerebellar gangliocytoma and was treated successfully with surgery. The background setting of Cowden's syndrome was not present in our case.
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Isolated cerebral venous thrombosis in long survival of uncorrected tetralogy of fallot patient p. 270
Bharat Bhushan, Vijay Sardana, Dilip Maheswari, Piyush Ojha
DOI:10.4103/ijhas.IJHAS_111_16  
The aim is to highlight isolated cerebral venous sinus thrombosis (CVT) may be a complication of long-standing uncorrected tetralogy of Fallot (TOF). We are reporting a 62-year-old female patient came in Neurology department in Government Medical College, Kota in November 2015. She was presented with a history of a headache and vomiting for 2 days followed by status epilepticus. She had TOF since childhood and developed secondary polycythemia. She had been underwent three times phlebotomy and also taking anticoagulation for 5 years. She had minimal cerebral arterial thrombotic evidence on radiological imaging, and clinical manifestations were less than expected in hyperviscosity conditions. On detailed investigations, we found that she had CVT secondary to secondary polycythemia. Now, she is being treated as severe risk subjects for CVT. We conclude that isolated CVT can be rare kind of presentation in TOF.
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LETTER TO EDITOR Top

A faculty training module on the art of counseling students on non-academic issues p. 273
M Kishor, Suhas Chandran, HR Vinay, KS Kusuma, Pratibha Kantanavar
DOI:10.4103/ijhas.IJHAS_73_18  
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