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   Table of Contents - Current issue
January-April 2018
Volume 4 | Issue 1
Page Nos. 1-62

Online since Tuesday, March 27, 2018

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National Medical Commission Bill: A Note for Consideration by the Parliamentary Standing Committee p. 1
V. R Minocha
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Neurocritical Care of Intracranial Brain Tumor Surgery: An Overview p. 4
Alexis R Narvaez-Rojas, Joulem Mo-Carrascal, Johana Maraby, Guru D Satyarthee, Samer Hoz, Andrei F Joaquim, Luis R Moscote-Salazar
The principal aim of neurointensive care in patients with intracranial tumor surgery is prevention, prediction, early detection, and the prompt treatment of postoperative complications. Maintenance of proper hemodynamic and adequate respiratory support is necessary to prevent postoperative mass effect due to cerebral edema, hydrocephalus, hematoma, and infarct causing cerebral herniation syndromes. Invasive blood pressure monitoring is usually recommended along with measuring intracranial pressure to allow the proper evaluation of cerebral perfusion pressure and an effective cerebral blood flow. For the effective neurocritical intensive care of surgical patients with brain tumors, good harmony, interaction, and communication between the neurosurgeon and the neurointensive team is of paramount importance.
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Quantitative and Qualitative Analysis of Micronuclei in the Buccal Mucosal Cells of Individuals Associated with Tobacco p. 12
Somya Sharma, Shalu Rai, Akansha Misra, Anusuya Sharma, Deepankar Misra, Raghu Dhanpal
Introduction: Micronucleus/micronuclei) have the potential to serve as an important biomarker in exfoliated cell. Exfoliated buccal mucosal cells can be evaluated using MN assay which can be applied to individuals practicing tobacco habits and are at risk of developing oral cancer. Material and Methods: 80 tobacco users and 20 non tobacco users as control were included in the study. Smears were taken and stained with H&E, feulgen, acridine orange. MN was counted using criteria given by Tolbert et al. Data was analyzed using SPSS software. Results: MN higher in tobacco users. The values obtained for the MN count in tobacco chewers using these stains were statistically significant (P<0.05). The values obtained for the MN count in tobacco smokers using these stains were statistically significant (P<0.05). Qualitatively a good score for staining intensity; MN outline and nuclear outline was obtained for acridine orange, followed by H&E and feulgen stain. Discussion: In our study quantitatively, MN was counted in maximum number using H&E stain, followed by acridine orange and feulgen. Qualitatively, MN count was best viewed using acridine orange stain under a fluorescence microscope, followed by H&E and feulgen under a light microscope. Conclusion: Assessment of MN in exfoliated cells is a promising tool to study epithelial carcinogens in the oral cavity.
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Medical Students’ Opinion and Perception of the Education Environment in a Medical College of Delhi, India Highly accessed article p. 18
Sandeep Sachdeva, Nidhi Dwivedi
Objective: To assess students’ opinion and perception regarding education environment in a government medical college of Delhi, India. Materials and Methods: Dundee Ready Educational Environment Measure (DREEM), a universal, culturally nonspecific, generic 50-item inventory tool was used. Each item is rated on a five-point Likert scale with score ranging from 0 to 4 where 0 = strongly disagree, 1 = disagree, 2 = unsure, 3 = agree, and 4 = strongly agree. MBBS students of three batches (2nd, 3rd, and 4th year) were considered in the present cross-sectional study. Results: A total of 117 (84.1%) available students could be contacted in person, out of whom 71 (60.7%) were males; 94 (80.3%) passed their 12th class from private/convent school; nearly 88 (75.2%) students opined that administration is student-supportive; and 111 (94.8%) were in self-assessment state of “happiness.” The overall mean DREEM inventory score (range, 0–200) among all the respondents was 130.34 (±15.76), which is suggestive of “more positive than negative.” Statistically (P < 0.05) higher DREEM score was found among senior medical students [score, 136.5 (4th year) vs. 131.9 (3rd year) vs. 123.6 (2nd year)]; those medical students who were globally satisfied (score, 131.2 vs. 119.3); satisfied getting admitted in current medical college (score, 133.0 vs. 115.7); and who opined that administration is student-supportive (score, 133.4 vs. 120.9). Gender, type of school, marks in 12th class, native place, current residence, supplementary (extra attempt) in university exam, current mental state (sad/happy), and professional satisfaction had no statistical bearing on overall DREEM score. Overall, none of the inventory item (score range, 0–4) had an avg. score more than 3.5, but the score of the majority (42/50, 84.0%) of question items in the present study was in the range of 2–3 points indicating the aspects of the environment that could be improved or enhanced. Conclusion: Within limitations, the study gauges the experiential learning environment from the students’ perspective indicating overall positive results and moving in right direction. Some challenges inherent with medical education and critical areas requiring strengthening were listed including social and leisure time student involvement.
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Evaluation of Short-Term Outcomes of Arthroscopic Bursectomy Without Acromioplasty for Shoulder Impingement Syndrome With Type I and Type II Acromia p. 26
Nishit Bhatnagar, Rajat Gupta, Deepak Gupta, Anurag Tiwari, Yugal Karkhur
Purpose: To evaluate the efficacy of arthroscopic bursectomy in impingement syndrome with type I and type II acromia. Materials and Methods: Patients of shoulder impingement syndrome that did not improve on 6 weeks of conservative treatment were included. Patients with hooked acromion and full thickness rotator cuff tear were excluded based on radiological and ultrasonographic assessment. Arthroscopic bursectomy was performed in the selected patients. Constant–Murley score was used for evaluation preoperatively and at fixed intervals till 12 weeks postoperatively. Wilcoxon signed ranks test was performed for statistical analysis of nonparametric data. Results: The average age of patients was 40.5 years. The majority of the patients were males (70%) with involvement of dominant side, and seven had involvement of the nondominant side. Type I acromion and type II acromion were seen in 10 patients each. Ultrasound was able to detect all patients who had rotator cuff tear (20%), as confirmed during diagnostic arthroscopy. Type II acromion was found in three out of these four patients. All parameters of the Constant–Murley score worsened at 2 weeks postoperatively but showed statistically significant improvement during subsequent follow-up. Eight patients (40%) were rated as having excellent result, four patients (20%) as having good result, four (20%) as having fair result. These 16 patients (80%) were satisfied with the overall result. Four patients had a partial thickness rotator cuff tear. Out of these, three had poor outcome and one had fair outcome. Conclusions: Satisfactory outcomes were achieved in 80% of our patients. However, four patients in our study did not show encouraging results, thereby stressing the role of extrinsic factors also in the pathogenesis of impingement syndrome. Hence we recommend arthroscopic busrectomy for patients with shoulder impingement syndrome after exhausting conservative treatment, excluding a hooked acromion and rotator cuff tear. Level of Evidence: Level II − prospective interventional study.
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Cognitive Improvement After Endovascular Treatment in a Case of Intracranial Dural Fistula With Concomitant Dementia p. 32
Marco Zenteno, Angel Lee, Guru D Satyarthee, Gabriel Pinilla, Amit Agrawal, Luis R Moscote-Salazar
Dural fistulas associated with dementia are rarely reported and, among these, intracranial dural fistulas constitute an infrequent etiology. Moreover, dementia associated with dural fistulas occurs due to venous hypertension leading to ischemic neuronal dysfunction. This case report describes a male patient exhibiting unusual features of dementia with a concomitant dural fistula compromising the superior sagittal sinus. The fistula was completely occluded via endovascular embolization. Two months after the interventional therapy, clinical assessment revealed complete improvement of executive functions. Afterward, the patient returned to his daily activities without impairment.
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Anabolic Steroid Abuse in Gym Enthusiasts – An Under-Recognized Cause of Cerebral Venous Thrombosis p. 38
Geeta A Khwaja, Abhilekh Srivastava, Aviraj Deshmukh, Neera Chaudhry
Anabolic steroid use is constantly increasing, especially among athletes and gym enthusiasts. Of the many dangers of this rampant drug abuse is a hypercoagulable state predisposing to cerebral venous thrombosis (CVT). Androgen abuse for bodybuilding or increasing muscle mass is an under-recognized cause of CVT in young males. We report one such case, which highlights that awareness regarding the dangers of androgen abuse needs to be propagated, and a careful history of androgen abuse is mandatory in young adults presenting with CVT.
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Chronic Ulcerative Eyelid Lesion: A Rare Manifestation of Tuberculosis p. 41
Anuj Taneja, Geetika Khurana Taneja, Sandeep Jain, Rajiv Garg
Any organ system in the body can be affected by tuberculosis (TB). While pulmonary TB is the most common presentation, extrapulmonary TB including ocular TB is also an important clinical problem. Most commonly, ocular TB presents as anterior uveitis or choroiditis, which is caused either by hematogenous infection or hypersensitivity after another organ infection. Eyelid involvement by TB is mostly secondary to orbital TB and often presents as a draining sinus. Isolated eyelid TB is, however, uncommon. We present the case of a 6-year-old girl with eyelid TB presenting as chronic nonhealing skin ulcer.
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Branchiootic Syndrome − Rare Case Reports of Patients With Complete Bilateral Branchial Fistulae p. 44
Divya Gupta, Suryaprakash Dhandapani, Ishwar Singh, Jai Chand Passey
Branchial arch anomalies are one of the most common congenital anomalies and are usually unilateral in nature. The bilateral occurrence of more than one anomaly is not only rare, but its presence along with hearing loss results in branchiootic syndrome, which has important clinical and genetic implications. Branchiootic syndrome is a part of the spectrum of branchiootorenal syndrome, which is a rare autosomal dominant condition with incomplete penetrance characterized by the malformations of the external, middle, and inner ear, hearing loss, branchial fistulae, and renal abnormalities. We shall be discussing two such rare cases in this article.
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Extrusion of Intracranial Tumor Mass—A Rare Phenomenon p. 48
Charandeep S Gandhoke, Simran K Syal, Ghanshyam D Singhal, Hukum Singh, Daljit Singh
Introduction: The extrusion of intramedullary spinal cord tumor is a well known fact. Charles Elsberg described a two-staged approach for the removal of these tumors. In the first stage, a posterior midline myelotomy was performed overlying the tumor followed by a nondural closure. During the second surgery, 7 days later, the extruded tumor, through the myelotomy, was removed. However, an extrusion of the intracranial tumor mass has never been reported. We report a rare case wherein there was extrusion of the intracranial tumor after the first surgery. Case Report: A 19-year-old male presented with chief complaints of headache, vomiting on and off, and blurring of vision in both the eyes since 2 months. The patient also complained of swelling over the right side of the skull. Radiological imaging was suggestive of a heterogeneous contrast-enhancing right parietal bone osteolytic lesion with subgaleal and intracranial extension. Right parietal craniectomy and a subtotal removal of the mass was done. Due to excessive blood loss and hemodynamic instability, it was decided to do a two-stage surgery. After 7 days, during the second operation, the brain had extruded the residual mass, which was lying just beneath the skin flap. A complete excision of the tumor with duraplasty using tensor fascia latae was performed. Conclusion: In some cases, two-stage surgery for the resection of large intracranial tumors is beneficial. However, two-stage surgery should only be undertaken as a damage control measure and not as a routine standard of care.
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Solitary Massive Hydropneumoperitoneum in Abdomen Roentgenogram: A Pointer Toward Perforated Viscous in an Abdominal Cocoon Highly accessed article p. 52
Manish K Mishra, Anubhav Vindal, Pawanindra Lal
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Giant Vesical Calculus in a Girl Child: Rare Case Report p. 54
Praveen Jhanwar, Vivek Parasher, Rahul Khatri, Vikas Gupta
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What is the Safest Specialty to Perform Neuroendovascular Procedures for Cerebral Vascular Lesions? What Should We Tell Our Patients? p. 55
Samer Hoz, Mohammed M AbdulAzeez, Mohamad Borhan, Osama M Al-Awadi, Luis R Moscote-Salazar
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National Health Protection Scheme: A Proposal in the Budget 2018 – Medical Care Facilities Essential for Utilizing the Proposal p. 59
V. R Minocha
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The Urgent Need for a New Drug to Contain Gonorrhea Infection p. 60
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
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Need for an Urgent Response to Counter the Risk of Famine and Malnutrition in the African Region: United Nations Children’s Fund p. 61
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
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