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   2016| January-February  | Volume 9 | Issue 1  
    Online since January 22, 2016

 
 
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ORIGINAL ARTICLES
Prevalence of Rhesus D-negative blood type and the challenges of Rhesus D immunoprophylaxis among obstetric population in Ogbomoso, Southwestern Nigeria
Adewale Samson Adeyemi, Hajara Titilope Bello-Ajao
January-February 2016, 9(1):12-15
DOI:10.4103/1755-6783.168722  
Background: Rhesus incompatibility could pose a major problem in pregnancy, and it could be the cause of obstetric failure in a handful of women. Implementation of programs for antenatal and postnatal (Rhesus D) RhD immune globulin prophylaxis has led to a significant reduction in the frequency of maternal RhD alloimmunization and associated fetal and neonatal complications. Aims: To determine the prevalence of RhD negative among the pregnant population attending the antenatal clinic of a young tertiary health institution in Ogbomoso, a semi-urban town in southwestern Nigeria, and also the challenges faced by this sub-population of pregnant women. Materials and Methods: A retrospective review of the antenatal and labour records of obstetric patient attending Ladoke Akintola University of Technology Teaching Hospital (LTH), Ogbomoso, Nigeria. Variables were expressed as percentages. Result: Of the 596 booked patient who had their blood group systems determined, 563 women (94.5%) were RhD-positive, and 33(5.5%) women were RhD-negative. Almost 50% of the Rh-negative pregnant women were primipara. Twenty-three (69.7%) of the study population had a previous delivery or abortion, but only 9 (39.1%) of these had the Rhesus anti-D immunoglobulin following the delivery or the abortion. One of the RhD-negative women had been sensitized to the RhD positive antigen from the previous delivery at the time of booking the index pregnancy. Of the study population that delivered in our facility, only 11 (33.3%) received the anti-D immunoglobulin after the delivery, and financial inability to purchase the anti-D immunoglobulin was a major reason for refusing the immunoprophylaxis. Conclusion: Although the prevalence of RhD negative still remains low, and the rate of Rh-immunoprophylaxis remains quite low in our obstetric population, the risk of haemolytic disease of the newborn with its attendant perinatal morbidity and mortality is real in our community. The anti-D immunoglobulin should be made available and affordable.
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Asthma-related knowledge, attitudes, practices (KAP) of parents of children with bronchial asthma: A hospital-based study
Kaushik Sudha Bhagavatheeswaran, Jyoti Bala Kasav, Awnish Kumar Singh, Surapaneni Krishna Mohan, Ashish Joshi
January-February 2016, 9(1):23-30
DOI:10.4103/1755-6783.168704  
Background: Prevention of asthma exacerbations is one of the major challenges of public health. Parents are crucial for exacerbation prevention and management at home. This study was conducted with the objective of assessing asthma knowledge in the parents of asthmatic children and to understand parents' attitude and practices in dealing with the exacerbation of their children's asthma. Materials and Methods: A convenient sample of 100 parents of asthmatic children was enrolled. Any parents (mother or/and father) with a child aged 8 years and above, diagnosed with bronchial asthma, and attending the Outpatient Department of Paediatrics, Saveetha Medical College and Hospital with his/her child in the study period could be included. Results: In this study, 62% children were male and 38% female, the average age was 12.53 years [standard deviation (SD) 2.95], and the average time duration for living with an asthmatic condition was 6 years (SD 3). Of the parents, 80% responded that they did not know what inhaled corticosteroids were and most (86%) of them did not know how they worked, while 41% were aware of aerosol therapy. Of the respondents, 87% had never used a Children's Asthma Control Test questionnaire and 78% said that they did not have any written action plan in case of their child suffering an asthma attack. Conclusion: There is an urgent need for the preparation of parental guidelines for preventing asthma exacerbations among asthmatic children living in India.
  4,974 28 -
REVIEW ARTICLE
Caries vaccine: A boom for public health
Richie Chhabra, Karan Rajpal
January-February 2016, 9(1):1-3
DOI:10.4103/1755-6783.168715  
Dental caries is one of the most common irreversible diseases of the tooth structure where a wide group of microorganisms are responsible as they are the main etiologic bacteria. To reduce the incidence and prevalence of dental caries, various modalities have been adopted over the years by modifying various etiologic factors. One of the latest advances is caries vaccine that involves the application of advanced genetic technique by modifying Streptococcus mutans (S. mutans) and using it as a dental vaccine. This review article highlights the mechanism and prospects for dental caries vaccine that in the times ahead will be a blessing for health care providers.
  4,002 21 -
ORIGINAL ARTICLES
Depression, mood change and self-esteem among adolescents aged 12-25 years with acne vulgaris in India
Saravanan Dharshana, Awnish Kumar Singh, Shruti Sharma, Surapaneni Krishna Mohan, Ashish Joshi
January-February 2016, 9(1):31-36
DOI:10.4103/1755-6783.168712  
Introduction: Acne vulgaris is a medical condition of serious concern among adolescents. This study was conducted with the aim to compare psychosocial factors such as depression, self-esteem, and social impairments between females who had acne vulgaris and those who did not have acne vulgaris. Materials and Methods: Fifty (50) female acne cases and 100 controls (hereafter nonacne participants) in the age group of 12-25 years who were seeking treatment at the Dermatology Outpatient Department (OPD) of Saveetha Medical College, were enrolled in the study. Information about sociodemographic profiles, disease management, and normative perception was gathered. Further assessment of self-esteem, cognitive and behavioral factors, and self-efficacy was done. Results: Seventy-four percent (74%) of the acne cases were overwhelmed by their skin condition, and this was found to be statistically significant (P < .0001). More than half (58%; P < .0001) of the acne cases experienced anger while thinking of their skin conditions. Half of the number of acne cases (52%) felt that people perceived them as being dirty due to their skin condition and that it hindered them from interacting with the opposite sex. Conclusion: Adolescent females who had acne reported difficulties in overcoming the emotional disturbances occurring due to acne vulgaris.
  2,871 27 -
CASE REPORTS
Fine-needle aspiration cytology of subcutaneous cysticercosis: A series of five cases
Kusum D Jashnani, Heena M Desai, Jyothi B Shetty, Inshita Pandey
January-February 2016, 9(1):73-75
DOI:10.4103/1755-6783.168695  
Taenia solium, a potentially dangerous parasite, causes human cysticercosis that can cause a gamut of manifestations affecting the various systems of the body. Sometimes, parasitic infestations present as only superficial palpable subcutaneous or intramuscular nodules that are usually mistaken for lymph nodes or benign tumors like lipoma, neurofibroma, or epidermal inclusion cysts. Fine-needle aspiration cytology (FNAC) has emerged as a useful tool in the diagnosis of these superficial parasitic lesions. It also helps in avoiding unnecessary open biopsy to obtain a diagnosis. We, herein, report a series of five cases of subcutaneous cysticercosis at different sites (axilla, chest wall, abdominal wall, lateral neck, and cheek) misdiagnosed as lipomas and lymph nodes and finally diagnosed on FNAC.
  2,423 21 -
ORIGINAL ARTICLES
Association between enamel hypoplasia and dental caries in primary second molars and permanent first molars: A 3-year follow-up study
Sakeenabi Basha, Roshan Noor Mohamed, Hiremath Shivalinga Swamy
January-February 2016, 9(1):4-11
DOI:10.4103/1755-6783.168719  
Context: Enamel hypoplasia is a defect caused by disturbances during enamel formation. These defects in the enamel present important clinical significance as they predispose a tooth to dental caries. Aim: The aim of this study was to assess the longitudinal relationships between enamel hypoplasia and caries experience of primary second molars and permanent first molars. Materials and Methods: The study sample consisted of 765 subjects who underwent dental examinations at both ages 6 and 9 by the calibrated examiner. Primary second molars and permanent first molars were scored for the presence of enamel hypoplasia for each participant. Caries presence and number of decayed and filled surfaces (dfs and DFS) were determined at ages 6 and 9. The relationships between enamel hypoplasia and caries experience were assessed using multivariable regression models. Results: At the tooth level, 2.8% and 3.5% of children had hypoplasia on primary second molars and permanent first molars respectively. Multivariable logistic regression analyses showed that children with enamel hypoplasia were at a significantly higher risk of caries at both ages 6 (odds ratio, OR = 5.27 for primary second molars and OR = 3.21 for permanent first molars) and age 9 (OR = 3.45 for primary second molars and OR = 4.57 for permanent first molars), and that a statistically significant association was seen with caries incidence (OR = 2.08 for primary second molars and OR = 2.87 for permanent first molars). Conclusion: Enamel hypoplasia appears to be a significant risk factor for caries in both primary second molars and permanent first molars and should be considered in caries risk assessment.
  2,349 25 -
KPC with ESBL: A multistarrer tragedy
Dibyendu Banerjee, Baishali Chakraborty, Arpita Nandan, Banya Chakraborty
January-February 2016, 9(1):16-18
DOI:10.4103/1755-6783.168709  
Background: One of the most dangerous carbapenemase is Klebsiella pneumoniae Carbapenemase or KPC, possessing the ability to hydrolyze the Carbapenems, and other beta-lactams as well like Penecillins, Cephalosporins, and aztreonam. Many members of the family Enterobacteriaceae and few other non-fermenters contain the gene blaKPC, which codes for the enzyme KPC, and hence this is transferrable. Although the reports of KPC producers are scanty from India, it is still a dark cloud on the horizon, with the ability to overcast the sky. Our main aim was to identify KPC producing isolates of Klebsiella pneumoniae in our Tertiary care Medical Institution. Materials and Methods: Over a 3 months period, we collected 54 isolates of Klebsiella pneumoniae from different samples. We performed sensitivity against a variety of antibiotics including 3 Carbapenems , 3 extended spectrum Cephalosporins, and co-amoxyclav, both by disc diffusion and E-test against Ertapenem. Results: Out of 54 isolates of Klebsiella pneumoniae, 38 (70.37%) showed resistance towards Ertapenem. Among these 38 isolates, 8 (14.81%) were found to be KPC producers. They were ESBL producers also. Conclusions: Ertapenem resistance is the most sensitive phenotypic marker for detecting KPC. Also, KPC shows resistance to the extended spectrum Cephalosporins. We found 38 isolates showing reduced susceptibility to Ertapenem (by MIC) - thus raising the chance of harbouring the enzyme. Truly, 8 among were confirmed as KPC and ESBL producers. All the microbiology laboratories should routinely search for KPC producers, using Ertapenem as a marker followed by confirmation with the three extended spectrum Cephalosporins.
  1,463 20 -
Can trichomonas immunochromatographic test increase the validity and reliability of WHO syndromic algorithm for vaginal discharge as a screening tool for trichomoniasis?
Hasini Banneheke, Rukshan Fernandopulle, Upul Gunasekara, Ankur Barua, Neluka Fernando, Renu Wickremasinghe
January-February 2016, 9(1):43-47
DOI:10.4103/1755-6783.168717  
Background: Trichomoniasis is a sexually transmitted parasitic infection. The World Health Organization (WHO) advocated flow charts for curable sexually transmitted infections (STIs) to improve the care. In this study, an attempt was made to evaluate the validity and reliability of WHO syndromic algorithm for vaginal discharge against trichomonas immunochromatographic test (ICT). Trichomonas ICT is a test with high validity, reliability, and feasibility. Objectives: The objective was to evaluate the validity and reliability of "WHO syndromic algorithm for vaginal discharge" against "trichomonas ICT" as a screening tool for trichomonas infection among women of reproductive age in the Western Province, Sri Lanka. Materials and Methods: This cross-sectional study was conducted in sexually transmitted disease clinics, well woman clinics, gynecology clinics, and institutional health clinics in the Western Province, Sri Lanka. We enrolled 100 women in the age group of 15-45 years using the stratified random sampling method. They were interviewed and examined and the specimens were collected to identify trichomoniasis by culture and ICT. Two-stage analyses were done to evaluate the performance of the WHO algorithm against Trichomonas ICT. Results: In a two-stage analysis, the specificity of syndromic algorithm improved from 80.9% to 94.4% while false positive rate reduced from 19.1% to 5.6%. The net effect of specificity was 98.7% while the false positive rate was 1.3%. Conclusion: The validity and reliability of WHO syndromic algorithm as a diagnostic tool for trichomoniasis can be improved by adding trichomonas ICT.
  1,455 21 -
CASE REPORTS
Tricuspid valve endocarditis with septic pulmonary embolism following induced abortion in an immunocompetent patient: A case report
Bidyut Kr Das, Indranil Chaudhuri, Suhas Gajbhiye
January-February 2016, 9(1):70-72
DOI:10.4103/1755-6783.168708  
Infective endocarditis (IE) is a life-threatening disease where infections most commonly involve heart valves but may occur at the site of a septal defect or chordate tendinea or on the mural endocardium. Infection of arteriovenous shunts, arterioarterial shunts (patent ductus arteriosus), or coarctation of the infective aorta are clinically and pathologically similar to IE. Conditions predisposing to native valve endocarditis are rheumatic heart disease (where the mitral valve is frequently involved followed by the aortic valve), congenital heart disease (commonly patent ductus arteriosus, ventricular septal defect, and bicuspid aortic valve), and intravenous (IV) drug abusers [tricuspid valve (TV) commonly involved followed by the mitral valve and the aortic valve]. We report a case of TV endocarditis in a 25-year-old female patient after induced abortion at 16 weeks of pregnancy presented with pyrexia of unknown origin (PUO) and septic pulmonary embolism. The patient presented with fever with chills and rigors 2 weeks after the induced abortion. She remained febrile for 1.5 months and did not respond to therapy. After subsequent investigations, she was found to have TV endocarditis. She was not an IV drug abuser and did not have any underlying cardiac anomaly or any cardiac prosthesis implantation, which are common causes of right-sided endocarditis. This patient had responded to injection ceftriaxone 1 g IV/twice a day (bd), injection vancomycin 500 mg IV/bd, and injection gentamycin 80 mg IV/bd for total 28 days and was discharged to follow-up.
  1,433 23 -
Idiopathic granulomatous hepatitis in an 11-year-old boy
Deepika Rustogi, Aashima Dabbas, Sangeeta Yadav
January-February 2016, 9(1):64-66
DOI:10.4103/1755-6783.168698  
Hepatic granulomas are reported in 2-15% of all liver biopsies that are attributable to various causes. Owing to the diverse prognostic and therapeutic implications, a detailed workup of all liver biopsies with granulomatous lesions is mandatory. The cause of the disease may remain obscure in up to 50% cases of "idiopathic granulomatous hepatitis" (IGH). This disease runs a chronic relapsing course. Hepatocellular dysfunction may be an early predominant manifestation unlike that in the available literature. Timely recognition and diagnosis of IGH is imperative as the disease responds well to immunosuppressants that can prevent permanent liver damage. We report a case of a young boy with IGH who was successfully treated with immunosuppressive therapy.
  1,362 21 -
ORIGINAL ARTICLES
Screening of infants with congenital cataract for rubella infection
Satti Abdelrahim Satti, Ebtihal Elyas Mohammed, Ahmed M Fahmi
January-February 2016, 9(1):19-22
DOI:10.4103/1755-6783.168721  
Background: Eye examination is a routine part of the periodic pediatric assessment. Prevention of visual impairment due to congenital cataract is now an international priority. Objectives: To screen infants with nontraumatic congenital cataract for rubella infection, then to determine the prevalence of congenital rubella syndrome (CRS), and to assess the associated problems. Design, Setting, Participants, and Intervention: A prospective hospital-based study conducted at two eye hospitals in Khartoum, Khartoum, Sudan, from March 15, 2011 to August 15, 2011. The studied group comprised infants, below 1 year of age, presenting with congenital cataract. A properly designed questionnaire was used for the collection of data. Blood samples of the infants were tested for the presence of specific immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies by the enzyme-linked immunosorbent assay (ELIZA) method. The data were statistically analyzed using SPSS software. Results: The number of studied infants with congenital cataract was 104, with the average age being 6.8 months. Male to female ratio in the positive cases was 1.3:1. Of the 104 children, 14 (13.5%) were positive for rubella infection. Of these 14 positive infants, 13 (93%) were below 6 months of age. This indicates that almost all the positive cases can be detected before the age of 6 months. Two (14.3%) mothers had a history of fever and skin rash during pregnancy. Of all the positive infants, 13 (93%) had bilateral congenital cataract. Conclusion and Relevance: Of the studied infants, 14 (13.5%) were positive for rubella infection, indicating a significant prevalence rate. Of the infants who were positive for rubella infection, 93% were below 6 months of age, indicating that the detection of this infection is highly possible early in life. So, taking the test as early as possible is recommended. Introduction of rubella vaccination in our national immunization program is recommended. Proper surveillance and reporting of all cases of CRS with urgent and long-term management programs are recommended. More studies on a larger scale are needed in our country.
  1,353 21 -
CASE REPORTS
Amoebic liver abscess with metastatic amoebic brain abscess: A case report
Mohd Younus Shah, Amarjit Singh Vij, Faisal Shah, Faizan Shah, Sachin Seth, Nazir Ahmad Pandith
January-February 2016, 9(1):76-79
DOI:10.4103/1755-6783.174724  
Background: Amoebic liver abscess may be single or multiple. It is mostly seen in tropical areas. Aims: Amoebic liver abscess may rupture into pleura, pericardium, peritoneum, etc but extension or metastasis to the CNS is extremely rare. That is what makes this case a rare one and worthy of sharing.
  1,334 20 -
ORIGINAL ARTICLES
Appraisal of cognitive function of diabetics in a rural healthcare teaching institute
Arup Bandyopadhyay, Pradip Kumar Mohanta, Gautam Sarker, Kamakhya Kumar, Debabrata Sarbapalli, Ranabir Pal
January-February 2016, 9(1):48-55
DOI:10.4103/1755-6783.168686  
Context (Background): Cognitive dysfunctions as the unexplored complications in diabetics need to be systematically studied. Aims: To assess the correlation between type 2 diabetes mellitus (DM) and associated cognitive dysfunctions with varying age groups and duration. Settings and Design: A hospital-based cross-sectional study was conducted in a tertiary care teaching institute in eastern India. Materials and Methods: In this study the participants were allocated into five groups according to duration of diabetes, for example, less than 3 months, 3 months-5 years, 6-10 years, 11-20 years, and more than 20 years. Each of these groups was then classified into following six subgroups according to age: group A (20 years or less), group B (21-30 years), group C (31-40 years), group D (41-50 years), group E (51-60 years), and group F (more than 60 years). A predesigned, pretested, semi-structured questionnaire was used to find the cognitive functions based on the Global Deterioration Scale (GDS) in diabetics and age-matched nondiabetic participants. Statistical Analysis Used: Statistical analysis using Statistical Package for the Social Sciences (SPSS) version 11.0 to calculate proportions and significance test were done in this study. Results: There was noticeable attenuation of cognitive functions in diabetics in all age groups irrespective of duration of the morbidity. Further, a distinct pattern of incremental cognitive dysfunctions was also noticed as the age progressed in diabetics and in healthy controls. Conclusion: Diabetics are more at risk of cognitive dysfunctions than age-matched controls, which needs more elaborative studies.
  1,264 21 -
Caregivers' perception of the attitude and skill of pediatricians attending to children in tertiary hospitals
Josephat M Chinawa, Herbert A Obu, Pius C Manyike, Ikechukwu E Obi, Awoere T Chinawa
January-February 2016, 9(1):37-42
DOI:10.4103/1755-6783.168696  
Background: When a pediatrician has the right attitude and displays good clinical skills, it is often associated with a wide range of positive health outcomes among children. Objectives: The objective of this study is to determine caregivers' perception of the attitude and skill of pediatricians attending to children in tertiary hospitals. Materials and Methods: This study was carried out in the pediatric wards of three teaching hospitals from two Southeastern states of Nigeria, namely, the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu, Enugu State University Teaching Hospital (ESUTH) (both in Enugu State), and Federal Teaching Hospital, Abakaliki (FETA) in Ebonyi State. A structured, self-administered questionnaire was used to collect information from the caregivers of children who were admitted in the hospitals during the study period. Results: A total of 227 respondents were involved in this study. Of all the children, 94 (41.4%) were females and 133 (58.6%) were males. Over a third of the caregivers, i.e., 78 (34.4%), did not know the cadre of the doctor who examined them while the majority, i.e., 204 (89.9%), believed that the doctors who examined them were qualified and competent. Moreover, over half of the respondents admitted that the doctors who examined their wards were either very good [83 (36.6%)] or good [84 (37%)]. Conclusion: Pediatricians and doctors who care for children in tertiary hospitals in Southeastern Nigeria are perceived by caregivers to be skillful, caring, and friendly.
  1,136 26 -
CASE REPORTS
Orthotopic liver transplantation in an adult with Caroli syndrome: Case report
Vaibhav K Sutariya, Pranjal R Modi, Anand H Tank
January-February 2016, 9(1):58-60
DOI:10.4103/1755-6783.168720  
When Caroli disease (CD), defined as a congenital dilation and ectasia of the segmental intrahepatic bile ducts with or without cystic dilatation of the extrahepatic biliary tree, is associated with congenital hepatic fibrosis, it is termed Caroli syndrome (CS). We describe the case of a 38-year-old woman with CS, having diffuse involvement of the liver, who was successfully treated with orthotopic liver transplantation (OLT).
  1,008 24 -
Fatal case report of concomitant hepatitis E and Salmonella paratyphi A infection in a sub-Himalayan patient
Monil Singhai, Vinita Rawat, Paramjeet Singh, Rajeev Goyal
January-February 2016, 9(1):56-57
DOI:10.4103/1755-6783.168714  
We report a case of fatal fulminant hepatitis E and Salmonella paratyphi A coinfection in a patient of the sub-Himalayan region. The patient presented with acute febrile illness accompanied with sudden unconsciousness. Concomitant infection can result an illness having overlapping symptom, resulting in a situation where the diagnosis and treatment of patient may be difficult.
  917 19 -
Aberrant anatomy of a maxillary first molar: A case report
Mansi Atri, Anup Nagraj, Saatvik Atri
January-February 2016, 9(1):61-63
DOI:10.4103/1755-6783.168688  
  877 33 -
Clinical and diagnostic challenges in a rare case of motor weakness with endocrinopathy: A case report
Ravinder Garg, Sukhminder Jit Singh Bajwa, Rakesh Aseri, Krishan Singh Kajal
January-February 2016, 9(1):67-69
DOI:10.4103/1755-6783.168699  
Electrolyte imbalance always poses challenging situations to the attending intensivists, particularly if it is associated with endocrinopathies and other comorbidities. One such rare clinical scenario is hypokalemic periodic paralysis (HPP) due to hyperthyroidism. The epidemiology of such a condition is slightly higher among males of Asian origin as compared to its universal occurrence. The diagnostic challenges in this clinical situation can lead to higher morbidity if timeliness is compromised from the presentation to active management. Moreover, atypical presentation of this pathologic condition further compounds the problem if it is associated with overt hyperthyroidism. Here, we report a unique case that presented to the emergency medicine department of our institute with weakness of all the four limbs and in which we faced all the diagnostic and management challenges as the clinical condition of hypokalemia was somehow dominated by overt hyperthyroidism.
  880 23 -
NOTICE OF RETRACTION
Retraction: An unusual case of refractory metabolic acidosis after homeopathic medicinal treatment

January-February 2016, 9(1):84-84
DOI:10.4103/1755-6783.174730  
  876 19 -
LETTERS TO THE EDITOR
First Thai MERS case: Importance of travel medicine
Viroj Wiwanitkit
January-February 2016, 9(1):80-80
DOI:10.4103/1755-6783.168706  
  658 21 -
Perception of practitioners of naturopathy practice education
Viroj Wiwanitkit, Wasana Kaewla, Sirirat Thothong
January-February 2016, 9(1):83-83
DOI:10.4103/1755-6783.168705  
  655 20 -
Professional advisor and mentor: An important process for the higher education system in public health
Viroj Wiwanitkit
January-February 2016, 9(1):80-81
DOI:10.4103/1755-6783.168701  
  631 21 -
Intolerance to postexposure antiretroviral drug use in medical personnel getting needlestick injuries
Somsri Wiwanitkit, Viroj Wiwanitkit
January-February 2016, 9(1):82-82
DOI:10.4103/1755-6783.168702  
  579 19 -
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