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  Most popular articles (Since January 27, 2015)

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Salient Features Regarding Medicolegal Certificate
Anil Aggrawal
January-April 2015, 1(1):45-51
General duty doctors in all major hospitals -Govt and Private-are often unclear regarding when to label a case as medicolegal. This paper attempts to give general guidelines to doctors regarding this problem.
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Wrist (Walker–Murdoch) and Thumb (Steinberg) Signs
Suruchi Gupta, Nikhil Gupta
May-August 2017, 3(2):111-112
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Kidney transplantation in India: Challenges and future recommendation
NP Singh, Anish Kumar
January-April 2016, 2(1):12-17
Successful kidney transplantation offers the best possible quality of life for patients with end stage renal disease (ESRD). Despite this, renal transplantation rates in the developing world are considerably lower than in the developed world. Identified reasons for this include lack of awareness, low education levels, lack of a clear national policy, absence of functional dialysis and transplant units with adequately trained staff, and absence of an organized system of organ retrieval from deceased donors and lack of opportunities to fund long-term immunosuppression. Measures to improve the quality of care should center on improvement of the socioeconomic status of the country. Key action points include the implementation of: (1) Chronic kidney disease (CKD) screening and prevention programs; (2) ESRD and transplantation registries; (3) transplantation legislation, covering both living and deceased organ donation; (4) international and regional collaborations for transfer of knowledge and technology. The government should make transplantation more affordable by strengthening the public sector hospitals and by making the transplant medication more affordable. With the National Organ Transplant Programme (NOTP) in the process of being established in India, the transplant community should strive to increase the organ donation awareness, improve the infrastructure for organ retrieval, storage and allocation in an equitable way.
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Liver transplant scene in india
AS Soin, S Thiagarajan
January-April 2016, 2(1):6-11
Over the last 17 years, liver transplant in India has evolved from a rarity to a common procedure available along the length and breadth of the country with survival data comparable to the best centres in the world. India is now in the forefront of Living donor liver transplant (LDLT) in the world, led by the team of the principal author. LDLT is possible for all types of recipients and indications with 95% success, with low incidence of vascular complications and biliary complications. While Deceased donor liver transplants (DDLTs) have picked up steam in Southern India, there is still a large gap between demand and supply of organs. LDLT is essential to bridge this gap and continues to be the main curative option for the majority of patients in India suffering from end-stage liver disease and Hepato cellular carcinoma (HCC) confined to the liver.
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A Study on Knowledge and Preventive Practices about Mosquito Borne Diseases in Delhi
Charu Kohli, Rajesh Kumar, Gajendra S Meena, Mongjam M Singh, Gopal K Ingle
January-April 2015, 1(1):16-19
Background: Mosquito-borne diseases constitute an important cause of morbidity and mortality, especially in India. Assessment of knowledge and practices of community about prevention of mosquito borne diseases is important for designing community-based interventions. Therefore, the study was carried out to assess such information. Materials and Methods: A community-based cross-sectional study was conducted among 350 adults selected by systematic sampling method in a rural and urban area in Delhi. Data was collected using pretested semi-structured questionnaire after taking written informed consent. Data was analyzed using SPSS version 17. Chi-square and Fisher's Exact test was used for qualitative variables to find association and P <</i> 0.05 was considered significant. Results: One hundred and forty-two (67.6%) subjects in rural and 89 (63.6%) in the urban area were able to name at least one mosquito borne disease. Only small number of participants (from rural 28.1% and urban 18.6% areas) was aware of "fever with chills and rigor" as a symptom of malaria. Television was most common source of information in both rural and urban areas. Desert coolers were reported to be cleaned regularly in a week in 86.4% houses in a rural area, and 88.4% houses in the urban area. Potential breeding sites were significantly more in urban (n = 34, 24.3%) than rural (n = 13, 6.2%) houses (P = 0.01). Similarly actual breeding of mosquitoes was found significantly more in urban houses (n = 29, 20.7%) than rural houses (n = 14, 6.7%), which was statistically significant (P = 0.01). Knowledge about mosquito borne diseases was significantly associated with education status of the participants. Conclusion and Recommendation: Level of awareness was good; however mosquito breeding was occurring more in urban areas, which demands innovative mass media techniques to convey health messages to the public for prevention and control of mosquito borne diseases.
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Organ donation and transplantation: An updated overview
Anika Sulania, Sandeep Sachdeva, Diwakar Jha, Gurmeet Kaur, Ruchi Sachdeva
January-April 2016, 2(1):18-27
This article reviews and describes the theoretical concept of organ donation (OD) and transplantation, historical milestones, need, shortage, status of global activities, health system capacity, survival outcome, and update on legislative environment in India, Central/State contribution and Nongovernment Organizations actively involved in OD.
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Basic Approach to Data Analysis and Writing of Results and Discussion Sections
Satyanarayana Labani, Komal Wadhwa, Smita Asthana
January-April 2017, 3(1):6-15
A research paper or thesis writing is considered hard and very difficult process of intense concentration and brain work. Readers generally are first interested in new results of the paper. Writing results section contains new results from research investigation but is difficult in comparison to writing methods section as the latter section is already written at the proposal writing stage and requires only language change. Results section is heart of the paper and its completion with methods section already written; implies more than 50% of paper or thesis writing work and it become 70% paper writing work with writing of discussion section. Results writing section should be organized into different segments of text and visuals such as tables, figures, algorithms, etc. In order to start writing results section, we make a beginning with data analysis and its presentation of key findings as summarized results to yield an answer to the research question that study attempted. Answers to the questions and interpretations are presented in the discussion section. Data analysis is primarily linked with writing text part of the results and discussion of results. This is a desired sequence to work with in paper writing. The attempt of working in such a sequence provides a convenient approach to young researchers or post graduate/under graduate medical students to gain confidence in writing a research paper or thesis or a research report. While basic knowledge of study design and analysis is needed, the involvement of a qualified bio-statistician is recommended in various stages up to publication. In this communication, we describe the basic approach of data analysis required for initiating writing results and discussion while quoting the required rules for the purpose.
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Anesthetic management of a patient with mitral stenosis undergoing mitral valve repair/replacement
Praveen Kumar Neema, Mukul Chandra Kapoor
May-August 2016, 2(2):94-98
The results of mitral valve surgery have improved steadily. The current operative mortality rates for mitral valve surgery are reported to be in the region of 1.5% for mitral valve repair and 5.5% for mitral valve replacement. To ensure good perioperative patient outcome, it is imperative to follow management techniques based on sound scientific principles. In this review article, the authors describe anesthetic management, complexities of cardiopulmonary bypass and weaning from cardiopulmonary bypass in patients of varying severity of mitral stenosis.
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Pathophysiology of Mitral Valve Stenosis
Praveen Kumar Neema
January-April 2015, 1(1):25-27
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Management of Upper Gastrointestinal Bleed
V Jain, PN Agarwal, R Singh, A Mishra, A Chugh, M Meena
May-August 2015, 1(2):69-79
Upper gastrointestinal bleed (UGIB) causes significant morbidity and mortality the world over. The two main causes have been due to increasing nonsteroidal anti-inflammatory drug use along with the high prevalence of Helicobacter pylori infection in patients with peptic ulcer and bleeding from gastroesophageal varices due to portal hypertension. Other causes of esophageal tears, gastrointestinal malignancy, and arteriovenous malformations also contribute to the morbidity and motality. Rapid assessment, resuscitation, and early endoscopy form the basis of early management of patients with severe bleeding. Risk stratification is based on clinical assessment and endoscopic findings. Early Upper gastrointestinal endoscopy (UGIE) (within 24 h of presentation) confirms the diagnosis and allows for targeted endoscopic treatment, which results in reduced morbidity, hospital stay, the risk of recurrent bleeding, and need for surgery. Despite successful endoscopic therapy, re-bleeding remains a risk and a second attempt at endoscopic therapy is recommended in most. Arteriography with embolization can serve as an extremely useful therapeutic option. Thanks to excellent medical and endoscopic control, surgery for UGIB is rarely required nowadays.
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Gynecomastia: A review of literature
Rekha Arya, Arun Kumar Rathi, Kishore Singh, Anurita Srivastava, Debashis Panda, Sailendra Narayan Parida, Archana Jha, Yogendra Kumar
May-August 2016, 2(2):69-75
Gynecomastia is a benign enlargement of the male breast tissue, either due to the proliferation of glandular tissue or deposition of fat in breast tissue, usually caused by imbalance of estrogen and androgen hormones in body. Gynecomastia has a trimodal age distribution and begins as a small lump beneath the nipple which may be tender. Gynecomastia is usually benign but may be a cause of embarrassment for some. Evaluation of gynecomastia is performed with an aim at diagnosing the cause for the same. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery depending on the etiology.
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Food safety in India: An unfinished agenda
Charu Kohli, Suneela Garg
September-December 2015, 1(3):131-135
Food safety refers to all those hazards which make the food unsafe to health. The unsafe food creates a vicious cycle of disease and malnutrition which affect all age groups but in particular children, the elderly, and the sick. Foodborne diseases are important hidden causes of morbidity. This article has been written with an objective to assess the current status of food safety and related issues in India and the measures to improve the same. Though most of the foodborne diseases are sporadic and often not reported in India, a nationwide study reported an alarming 13.2% prevalence at the household level. Currently, the mainstay for food safety in India is a legislative approach. The Indian food industry is regulated by the number of legislations covering sanitation, licensing, and permits. Food Safety and Standards Authority of India established by the Government of India develop the standards for food and regulate and monitor the manufacture, processing, storage, distribution, sale, and import of food so as to ensure the availability of safe and wholesome food for human consumption. The literature review shows that the consumer awareness is not very good in India in relation to food safety. There is a need to initiate the public health surveillance for food safety and foodborne diseases. Legislations related to food safety should be enforced strictly. The consumer awareness should be an important part of all initiatives.
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Plastination: An innovative method of preservation of dead body for teaching and learning anatomy
Anita Mahajan, Shilpi Agarwal, Swati Tiwari, Neelam Vasudeva
January-April 2016, 2(1):38-42
Background: Plastination is the process to preserve the perishable biological tissues for long time using curable polymers. This technique was invented by Gunther Von Hagens, a German anatomist, in 1977. Since then, there have been many modifi cations according to the need and availability of infrastructure in various institutions. Many deviations from the standard plastination procedure have been suggested and used successfully. Methods: Modified short plastination protocol using epoxy resin has been adopted and standardized by the Department of Anatomy, Maulana Azad Medical College. Results and Conclusion: This technique provides dry, odorless, durable, nontoxic specimens that are easy to handle and can be stored at room temperature indefi nitely. This can be performed in a short period of time with limited and less expensive infrastructure. Our department organizes regular national workshops on “body preservation techniques” to train young anatomists.
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Mechanisms and pathophysiology of mitral valve regurgitation
Praveen Kumar Neema
September-December 2015, 1(3):142-146
The mitral valve (MV) is a sophisticated natural engineering marvel. The MV requires coordinated action of all its interrelated anatomical components: The MV leaflets, the annulus, the left atrium, the tendinous chords and the papillary muscles with its surrounding left ventricular wall for an effective closure of its orifice. Mitral valve regurgitation (MR) is frequently found in patients undergoing cardiac surgery with cardiopulmonary bypass. MR can be secondary to a structural or a functional defect of one or several components of the MV. The mechanism(s) of functional MR is the most complex. A precise understanding of the pathophysiology of MR helps resolving the cardiac status of a patient and choice of therapy for a particular patient. Transesophageal echocardiography can define the underlying mechanism(s) of MR; a thorough understanding of the mechanism(s) helps deciding the surgical procedure needed to repair the MR. In this article, the author reviews the mechanisms and pathophysiology of MR.
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Intracranial T1 Weighted Hyperintense Lesions
Neetika Gupta, Aishwarya Gulati, Arif Mirza, Vaibhav Gulati, Parveen Gulati
May-August 2017, 3(2):61-72
Most of the intracranial pathologies appear hypointense on T1-weighted images. However, there are some intracranial substances and pathological lesions that appear hyperintense on T1-weighted images. This article aims to highlight the various cranial lesions showing hyperintense signal on T1-weighted images. Various substances which are responsible for the intrinsically high signal intensity observed in intracranial lesions at T1-weighted magnetic resonance imaging such as methemoglobin, melanin, lipid, various minerals, and other will be enumerated, and how these signal changes can lead to more specific diagnoses will be discussed.
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A Reformed Corrosion Cast Technique using Commercially Available Polyvinyl Chloride Solution
Sabita Mishra, Madhu Sethi
January-April 2015, 1(1):28-30
Corrosion cast technique has advanced since its first application using wax by Leonardo da Vinci in 16 th century. Various materials such as metal alloys, celloidin, latex gum, synthetic resins/epoxy resins, polyester resins, and silicone have been used to prepare cast of vasculature and ductal architecture. However, the current reformed technique as described used commercially available polyvinyl chloride (PVC) solution to prepare cast of vascular/ductal anatomy. This technique being cost-effective and rapid can be easily applied in low resource situation. The Department of Anatomy Maulana Azad Medical College, New Delhi standardized this technique to prepare corrosion casts using PVC solution and is regularly training participants in the annual workshop on "body preservation techniques on embalming plastination and musemology" conducted by the Department.
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From rote to reasoning: The paradigm shift required in medical entrance examination and beyond!
Pawanindra Lal
January-April 2016, 2(1):1-5
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Should Abnormal Vaginal Flora in 2 nd Trimester of Pregnancy be Treated to Prevent Preterm Labor
Gunjan Kumari, Anjali Tempe
May-August 2015, 1(2):64-68
Screening and treatment of abnormal vaginal flora during pregnancy to prevent preterm labor is a matter of debate for practicing obstetrician and physician in a country where maternal health and its outcome is a big concern. The recent evidence suggests that infection may be implicated in a substantial proportion of cases of preterm delivery. Neonatal morbidity and mortality are primarily influenced by gestational age and less so by birth weight. Microbial flora normally present in the human vagina play a key role in preventing pathological organisms including those responsible for sexually transmitted diseases, yeast infections, bacterial vaginosis (BV), and urinary tract infection. The outcome gathered from various recent studies have been remarkably consistent and managed to support the hypothesis that antibiotic treatment before 20 weeks of gestation reduces the risk of preterm birth. It is concluded that screening for abnormal vaginal flora cannot be generalized, but it may be safely carried out in pregnant women who have a previous history of preterm labor. Antibiotics with lactobacillus treatment can eradicate abnormal vaginal flora in pregnancy, however, screening and treating all pregnant women with asymptomatic BV to prevent preterm birth and its consequences is not substantiated by evidence.
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Apixaban: An oral anticoagulant having unique mechanism of action with better safety and efficacy profile
ZA Fazeel
May-August 2016, 2(2):63-68
Anticoagulants are routinely used in stroke, embolism, infarct, etc. Blood clotting profile in such patients needs to be monitored frequently. Anticoagulants which can be administered orally such as warfarin and dicoumarol are preferred in such patients. Injectable anticoagulants such as heparin are prescribed when anticoagulation therapy is required for short duration. Absence of oral form of heparin makes it impractical for long-term use. Currently, warfarin and coumarone derivatives are the best available oral anticoagulants in market. They act by inhibiting decarboxylation of blood clotting factors II, VII, IX, and X. Pharmacological response of warfarin and dicoumarol needs to be monitored by frequent assessments of prothrombin time (PT) and international normalized ratio (INR). There is a need for a drug which can overcome these limitations. Apixaban is an oral anticoagulant which acts by inhibiting factor Xa. It does not require laboratory monitoring of PT and INR. Hence, it overcomes the limitations of heparin and warfarin. It acts by selectively inhibiting the activated factor Xa in a reversible manner. Apixaban has an oral bioavailability of ~50%. It is administered as twice daily dose. It is excreted in urine and feces. Apixaban is useful in atrial fibrillation, venous thromboembolism, and pulmonary embolism. Bleeding is the major side effect of apixaban. It has been found that apixaban has superiority over warfarin and aspirin in terms of efficacy and safety. Further studies are required to monitor and assess the pharmacokinetics, efficacy, adverse effects, and drug interaction data in many populations and sub-populations throughout the world.
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Whither Medical Education and Healthcare?
Pawanindra Lal
May-August 2015, 1(2):59-63
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A Comparative Evaluation of Phacotrabeculectomy with Manual Phacofracture Trabeculectomy
Kirti Singh, Ankush Mutreja, Pooja Jain
January-April 2015, 1(1):6-11
Purpose: To compare the results of manual phacofracture trabeculectomy (manual small incision cataract surgery trabeculectomy) versus phacotrabeculectomy with respect to visual gain and intraocular pressure (IOP) control. Materials and Methods: Thirty consecutive patients who underwent combined surgery performed by the same surgeon were prospectively evaluated for a minimum period of 12 months. Fifteen patients underwent single site phacotrabeculectomy, and the remaining 15 patients underwent single site phacofracture trabeculectomy at Guru Nanak Eye Hospital, New Delhi. Results: Both surgeries resulted in a highly significant decrease in IOP, the final percentage reduction being 46% in phacotrabeculectomy group and 44% in phacofracture trabeculectomy group. The complete success rate (IOP < 21 mmHg) without additional antiglaucoma medications was 100% for both the groups till l2 months of follow-up. Improvement in visual acuity was similar in both the groups with 53% patients in phacotrabeculectomy and 60% in phacofracture trabeculectomy group attaining a final visual acuity of 20/40 or better. The mean surgically induced astigmatism was 1.33 D and 1.3 D in phacotrabeculectomy and phacofracture trabeculectomy group respectively, at the end of 12 months follow-up. Manual phacofracture trabeculectomy resulted in more early postoperative inflammation within the first 7 days. Conclusions: There was no statistically significant difference in the final visual acuity, IOP control and surgically induced astigmatism between phacofracture trabeculectomy and phacotrabeculectomy groups.
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Prevalence of Risk Factors for Noncommunicable Diseases in Working Population
Sumita Sandhu, Raman Chauhan, SR Mazta
May-August 2015, 1(2):101-104
Objectives: Noncommunicable diseases (NCDs) are the leading causes of death globally, killing more people each year than all other causes combined. NCDs are caused to a large extent by four behavioral risk factors that are pervasive aspects of economic transition, rapid urbanization, and 21 st century lifestyles: Tobacco use, unhealthy diet, insufficient physical activity, and the harmful use of alcohol. The aim was to find out the prevalence of risk factors for NCDs in working population. Materials and Methods: A cross sectional study was conducted in working population aged 18 years and above in 10 public institutions. World Health Organization STEPS approach was used to find the prevalence of risk factors. The study sample was randomly selected by using random number generator. Results: A total of 350 participants were included in the study. The overall prevalence of tobacco use was 23.4%. The prevalence of alcohol consumption was 36%. Thirty three percent of the participants was consuming more than five servings of fruits and vegetables per day. Physical inactivity was seen in 51%. 33.1% of the participants were overweight, 6% were obese and 32.6%, 5.8% were hypertensive and diabetic, respectively. Conclusions: This study shows the high burden of risk factors for NCDs in the working population. Action should be oriented toward curbing the NCD risk factors and promoting healthier lifestyles to reduce NCD incidence rates and delay the age of NCD onset.
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Medicolegal aspects of road side accident victims
Anil K Aggrawal
September-December 2016, 2(3):141-143
Medical professionals are often unsure of the course of action in medico-legal cases. Thus they are rather reluctant to attend to cases of accident for fear of being involved in unnecessary litigation later on. Even in cases of serious accidents, medical professionals hesitate to offer help, sometimes resulting in patient's death. This paper highlights some important legal precautions to be taken care of in cases of road side vehicular accidents. These simple steps, if observed by medical practitioners, will prevent unnecessary litigation.
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Duodeno-jejunal Atresia with Apple-peel Appearance of the Remaining Ileum: A Rare Association
Abhishek Chinya, Simmi K Ratan, Satish Kumar Aggarwal
January-April 2015, 1(1):34-36
Intestinal atresia is a common cause of neonatal intestinal obstruction. We present a rare case of duodenal atresia, multiple jejunal atresias, and apple peel appearance of the remaining ileum in a 3-day-old neonate. Multiple jejunal atresias were resected, and a duodenojejunostomy was performed. Although duodenal atresia is believed to result from failure of vacuolation process, this very rare association of duodenojejunal atresia with apple peel appearance of the ileum suggests that some vascular injury occurring during late gestation might also lead to duodenal atresia.
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Carbapenem Resistance Patterns in General Intensive Care Unit of a Tertiary Care Hospital in India
Deepak K Tempe, Jyotsna Agarwal, Kapil Chaudhary, Parin Lalwani, Madhu Sudan Tudu, Upendra Hansdah, Bibhavati Mishra
May-August 2015, 1(2):85-91
Aim: Carbapenems are one of the last resort drugs against drug-resistant organisms and carbapenem resistance (CR) is increasingly being reported. The present study evaluated the CR pattern in general Intensive Care Unit (ICU) of a tertiary care hospital in India. Materials and Methods: This was a retrospective analysis of data collected from May 2011 to January 2012 of 40 patients admitted in the general ICU with a stay of more than a week. The clinical and demographic data, Sequential Organ Failure Assessment (SOFA) score, need for mechanical ventilation, antibiotic sensitivity reports, and outcome were assessed. The results were statistically analyzed using Student's t-test, Mann-Whitney U-test, Chi-square test, and Fisher's exact test, where appropriate. P < 0.05 was considered statistically significant. Results: Acinetobacter baumanii was the most common organism in tracheal samples, Pseudomonas aeruginosa in blood samples and Escherichia coli in urine samples. CR in fresh episodes was seen maximally with Acinetobacter baumanii (79%) and Pseudomonas aeruginosa (70%). Meropenem resistance (MR) was more common than imipenem resistance in CR organisms. High sensitivity among CR organisms was observed to tigecycline and colistin, and among carbapenem sensitive organisms to tigecycline, piperacillin-tazobactam combination, and levofloxacin. CR was prevalent with age >50 years (P = 0.002), ICU stay of >15 days (P = 0.002), mechanical ventilation (P = 0.003), and ventilation >10 days (P = 0.008). Mortality was more common among mechanically ventilated patients (P = 0.002) and those with higher SOFA scores on admission (P = 0.012). Conclusion: Carbapenem resistance is high in microbiological cultures of ICU patients with a stay for over a week. Acinetobacter baumanii and Pseudomonas aeruginosa were the most common CR organisms. MR was more common than imipenem resistance.
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