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   Table of Contents - Current issue
July-December 2017
Volume 20 | Issue 2
Page Nos. 115-207

Online since Tuesday, November 14, 2017

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Nail changes in oral lesions: A clue to diagnosis Highly accessed article p. 115
Tibin K Baby, G Umesh Chandra Prasad, S Sunil
Although most nail abnormalities are reactional and nonspecific, some occurs in conjunction with single or multisystem disorders and drug insults which may have associated oral manifestations. Understanding nail changes in oral lesions aids prompt investigations and correct diagnosis. These nail changes are broadly classified into color, structural, and contour nail alterations. This review focuses mainly on oral lesions with clinical nail abnormalities along with brief pathogenesis that is readily recognizable by dental specialists.
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Choroidal metastasis: A review of literature Highly accessed article p. 122
Deepti Sharma
Choroidal metastasis is a significant clinical problem in patients with metastatic cancer owing to abundant vascular supply. The two most common cancers leading to choroidal metastases are breast cancer followed by lung cancer. The treatment of choroidal metastasis depends on the status of primary disease, number, and location of choroidal metastasis, symptomatology and the general condition of the patient. A number of options are available for the therapy of ocular metastasis, including observation, chemotherapy, photocoagulation, cryosurgery, surgical resection, or radiotherapy. A database search was conducted on Google scholar and PubMed using phrase words, using the terms “choroidal metastasis,” in combination with terms such as “treatment,” “features,” or “diagnosis.” References of all publication were also searched. All relevant publications were collected, reviewed, and analyzed.
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Current state of salivaomics and metabolomic profiling as novel diagnostics for biomarker research and applications in oral cancer and personalized medicine p. 127
Simi Thankappan, N Sherin
Biomarkers are the main focus of current researches in biological characteristics that are easily measured in patients, and their discovery has laid the foundation for personalized medicine. Salivaomics and metabolomics are the rapidly emerging diagnostics focused on comprehensive profiling of metabolites in intracellular or biofluid sample. A systematic search of PubMed Central, Ebsco Host, Science Direct, and Scopus was done and the search terms included salivaomics, metabolomics, biomarkers, metabolites, oral cancer, proteomics, personalized medicine, and omics. This review article summarizes on the significance of salivary metabolites as diagnostic and prognostic biomarkers due to different biochemical pathways in oral cancer patients and healthy controls, even early detection of cancer in patients, thus emphasizing on the rigorous need of future research in this field.
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Changing epidemiology and antimicrobial resistance pattern of Vibrio cholerae isolates at a tertiary care health laboratory in North India (2011–2015) p. 132
Beena Uppal, Bhanu Mehra, Pragyan Swagatika Panda, Shyam Kishor Kumar
Background: Vibrio cholerae is a common bacterial enteropathogen causing acute diarrheal disease in the developing world. Marked variations in epidemiology and in in vitro susceptibility of isolates are commonly observed, and emerging and progressive resistance to various classes of antibiotics is frequent. The present research was undertaken to document the epidemiological profile of cholera cases in Delhi and surrounding areas and to monitor the antibiotic resistance patterns of this enteropathogen across the study years. Materials and Methods: The present retrospective analysis was conducted over a 5-year period (2011–2015) at a tertiary care medical center in New Delhi, India. A cumulative 11,570 diarrheic/dysentric fecal samples received in the laboratory were processed for common enteropathogens by standard bacteriological methods. Any suspected V. cholerae colonies were identified by standard biochemical reactions, and serological confirmation was obtained by agglutination using specific antisera. Antimicrobial susceptibility profile of the isolated strains was assessed by Kirby–Bauer's disc diffusion technique and in accordance with the Clinical and Laboratory Standards Institute guidelines. Results: V. cholerae was isolated in 2.4% of the stool samples, with V. cholerae O1 serotype Ogawa being the most prevalent serotype, and a rise in the number of cholera cases was evident during monsoon season each year. While resistance to nalidixic acid and ampicillin was consistently high during the study period, aminoglycoside resistance showed variance and fluctuations across the study years. Further, a significant rise was seen in resistance to ciprofloxacin and cefotaxime. Conclusions: Our findings suggest high levels of antibiotic resistance among the circulating V. cholerae strains in this part of the country, with fluctuations in antibiograms being commonly noted. Therefore, active and continuous community surveillance of changing epidemiology and antimicrobial resistance profile of this enteropathogen is of utmost importance.
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Impact of structural and interpersonal components of health care on user satisfaction with services of an outpatient clinic of a Nigerian tertiary hospital p. 139
Godpower Chinedu Michael, Ibrahim Aliyu, Bukar Alhaji Grema, Thomas D Thacher
Background: Patient satisfaction plays a key role in health-care reforms and service delivery. It is determined by patient's perception of the structural, interpersonal, and technical components of care. With current efforts toward universal coverage, government-owned National Health Insurance Scheme (NHIS)-accredited health facilities may need to improve the structural and interpersonal aspects of patients' care to survive in the emerging competitive health-care industry in Nigeria. Materials and Methods: A cross-sectional study of 220 NHIS enrollees randomly selected from patients attending the Staff Clinic of Aminu Kano Teaching Hospital Kano assessed patients' satisfaction with the structural (service-window-locations, cleanliness, adequacy of seats and toilets, and staff sufficiency) and interpersonal (staff friendliness, communication, respectfulness, response-to-requests, and efficiency) components of care as well as overall clinic satisfaction using a modified general practice assessment questionnaire. Results: Most of the respondents (65.9%) were satisfied with the clinic services. Respondents' satisfaction with the clinic's cleanliness, ease in locating medical records' unit and retrieving laboratory results, adequacy of doctors, friendly/respectful and responsive cashiers and clinical assistants (CAs), receiving satisfactory explanation on how to use prescribed drugs and unavailable drugs were all associated with the overall clinic satisfaction. However, cashiers' efficiency (odds ratio [OR] = 6.5, P = 0.006) and CAs' responsiveness (OR = 5.0, P = 0.03) were the predictors of overall satisfaction. Conclusion: Improvements in patients' overall satisfaction with the clinic services may require increasing the proportion of patients satisfied with the cashiers' efficiency and CAs' responsiveness (or those with similar roles) in service delivery.
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Retroprospective analysis of types of visual field defects (Octopus 900 perimeter-based study) at Shimla Hills p. 149
Kalpana Sharma, Ram Lal Sharma, Kulbhushan Prakash Chaudhary, Ravinder Kumar Gupta
Aim: This study aims to study the types of visual field defects (VFDs) among the patients who underwent automated perimetry. Subjects and Methods: This study was the analysis of VFs of the patients who underwent VF recording on Octopus 900 perimeter (HAAG-STREIT, AG, Switzerland) at Shimla hills (IGMC, Himachal Pradesh, India) situated at the height of 7 200 feet above sea level. Results: Among the most common causes of VFDs in glaucoma (n = 119) the most common VFD was paracentral scotoma (44.4%) followed by arcuate scotoma (23.42%). The next common cause leading to VFD was nonocular neurological (n = 33) in which the most common VFD was quadrantanopia (27%) followed by bilateral temporal hemianopia (18%). Other ocular causes of VFD were cataract, age-related macular degeneration, central retinal vein occlusion, branch retinal vein occlusion, diabetic retinopathy (DR), anterior ischemic optic neuropathy, retinitis pigmentosa, and optic neuritis. Conclusion: This study concludes that the most of the patients for whom perimetry was performed on Octopus 900 perimeter under ocular conditions, the glaucoma was the most common disease. The second most common cause of VFD was neurological, the common lesions being head trauma, cerebrovascular accidents (CVA), and pituitary adenomas. Therefore, the stimulus for this work was not only ophthalmological but also neurological. Therefore, VF measurement is critical component in diagnosing not only glaucomatous VFD but also other nonocular and ocular blinding conditions.
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Use of allogenic bone graft in the treatment of benign osteolytic bone lesion p. 155
OP Lakhwani, Mohit Jindal, Shashank Agarwal, Keerty Garg
Introduction: Management of benign osteolytic lesions of bone involve intralesional excision and filling of the bone defect. Allograft used as a filler in these lesions confer advantages of being available in sufficient quantity without the risk of donor site morbidity. However use of allografts may carry a potential risk of infection and has debatable osteogenic potential. This study used Allogenic Bone Graft using antibiotic impregnated allografts and adjuvants like bone marrowso as to address these shortcomings. Materials and Methods: Eight cases of benign osteolytic lesions were treated by intralesional curettage and bone grafting using allogenic bone graft. Appropiate surgical procedure for fixation was done wherever necessary. Five cases had Allogenic Bone Graft impregnated with vancomycin solution. Three cases had autogenic bone graft while 1 case used bone marrow as adjuvant. Outcome was assessed in terms of fracture healing, infection and osteointegration. Results: In all the cases adequate osteointegration and complete healing of the lesion was observed in all the cases with time period of healing closely matching that of complete osteointegration. There was no statistically significant difference in the duration of osteointegration and bone healing between vancomycin impregnated group vis a vis allograft used alone. Only one case developed infection who responded to Intravenous antibiotics. No failure was observed in this study was probably due to use of adjuvants in half of the cases. Discussion and Conclusion: Use of allogenic bone graft alongwith adjuvants (bone marrow and autologous bone graft) appears to be effective in treatment of benign lytic lesions. Healing rates may be attributed to use of osteogenic potentiators. Vancomycin impregnation of allograft appears to be a beneficial step in controlling the graft related infection and does not affect graft osteointegration and bone healing.
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Prevalence and outcome of perinatal asphyxia: Our experience in a semi-urban setting p. 161
Ibrahim Aliyu, Teslim O Lawal, Ben Onankpa
Introduction: Perinatal asphyxia is a significant cause of infant morbidity and mortality globally. Although considerable achievement has been made in reducing the impact of infectious diseases, much is yet to be seen in reducing the menace of perinatal asphyxia especially in semi-urban and rural areas. Materials and Methods: Data from medical records of all cases of perinatal asphyxia admitted over the study period of 30 months were retrieved and documented for the study. Results: Total admission to the special care baby unit was 1040, with 257 reported cases of perinatal asphyxia hence a prevalence of 24.7%. There were 149 (60.3%) males and 98 (39.7%) females; male:female ratio of 1.52:1. The gestation ages at delivery of the cases ranged from 35 to 44 weeks with mean of 38.02 ± 1.95; while the weight on admission ranged between 1.16 and 4.70 kg; mean weight of 2.97 ± 0.60. One hundred and eighty (72.9%) of the mothers were unbooked. About 73.3% of the deliveries occurred in the study center; vaginal deliveries accounted for 142 (57.5%) of the cases. Labor lasted between 18 and 24 h in 129 (52.2%) of the cases; however, eclampsia was the most common illness documented in these mothers. Two hundred and sixteen (87.4%) cases were discharged without documented complication, while seven deaths (2.8%) were recorded. Conclusion: Perinatal asphyxia is still prevalent in our setting; preventive measures should be adopted to reduce the disease burden by improving accessibility to health care, and also providing and increasing the acceptance of maternal antenatal care.
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Accuracy of clinical and ultrasound examination of palpable breast lesions in a resource-poor society p. 166
Uzoamaka R Ebubedike, Eric O Umeh, Stanley N. C. Anyanwu, Eric C Ihekwoaba, Ochonma A Egwuonwu, Cornelius O Ukah, Mike E Onwukamuche, Chiemelu D Emegoakor, Igwebuike V Onyiaorah, Daniel D Anyiam, Gabriel U Chianakwana
Background: Palpable breast masses are common presentations in resource-poor societies. Clinical and ultrasonographic breast examinations are commonly available means of evaluation. Objective: The objective of this study was to compare the accuracy of clinical breast examination (CBE) and ultrasonography in the diagnosis of palpable breast masses. Methodology: Consenting females presenting with palpable breast masses at the general surgical outpatient clinic were assessed clinically by the most senior surgeon, ultrasonographically by two radiologists, and the diagnosis compared with histologic examination. Results: One hundred and thirteen patients were recruited during the study period from January 2013 to April 2014. Of these, 53 patients (46.9%) had breast core biopsy, while 60 (53.1%) had open surgical biopsy. Only 67 (59.3%) patients had their histological results available. The mean age was 41.58 years (range 16–78). CBE achieved a sensitivity of 82.1%, specificity 67.9%, positive predictive value (PPV) 78%, negative predictive value 73%, overall accuracy 76.1%, false positive rate 32.1%, and false negative rate 17.9%. Breast ultrasonography had a sensitivity of 86.8%, specificity 72.4%, PPV 80.5%, negative predictive value 80.8%, overall accuracy 80.6%, false positive rate 27.6%, and false negative rate 13.2%. Conclusion: This study revealed no statistical significant difference between the accuracy of CBE and breast ultrasonography. We recommend that both should be used in the evaluation of palpable breast masses.
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Childhood injuries in a teaching hospital setting, Nnewi, South-East Nigeria p. 171
Anthony Ifeanyi Ugezu, CC Ihegihu, NC Chukwuka, CU Ndukwu, RO Ofiaeli
Background: Injuries resulting from accidents are of the most common cause of morbidity, mortality, and disability in childhood. Injuries in children are global problem occurring in all countries of the world. Aim: The aim of this study is to determine the pattern of injuries sustained during childhood and to recommend appropriate preventive measures. Materials and Methods: This is a hospital-based retrospective study, which comprised patients aged 18 years and below who presented with injuries at Nnamdi Azikiwe University Teaching Hospital, Nnewi, between January 2012 and December 2016. Patients with burn injury were excluded from the study. This is because the authors did not manage burn cases. Patients with incomplete records were excluded from the study. Results: Four hundred and twenty-nine patients' case records were reviewed. These patients sustained 549 injuries. Twenty-eight patients had multiple injuries. Their ages ranged from 1 day to 18 years with a mean age of 8.01 ± 2.2 years. 46.9% of the patients were 4–12 years of age. More males were affected than females with a ratio of 1.4:1. 48.2% of the patients sustained their injuries along the roads. Road traffic accidents were the leading cause of injury (48.2%) followed by falls (21.7%), with birth trauma accounting for 9.1% of cases. Fracture was the most common injury sustained accounting for 321 cases (58.4%) with 28.2% being open/compound. The time of these injuries occurs more in the morning and afternoon of the day. Conclusion: The prevention of these childhood injuries would involve public health education on identification of child hazards and safety measures. There is a need for legislation to outlaw certain activities such as street trading and hawking of wares/goods by children which exposes them to injuries. There is also a need to improve road designs by including zebra crossing and speed breaks on roads to curtail the magnitude of these injuries. Enforcement of road safety measures is also important.
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Epidemiological profile of injuries due to fall reporting to a tertiary care centre in a rural area of Northern India p. 175
Bhanu Awasthi, Sunil Kumar Raina, Uttam Singh, Sandeep Kalia, Lokesh Thakur
Background: Fall is an important contributor to injury and studies conducted over a period of time have established reliable estimates of the incidence of fall-related injury. The current study was aimed at identifying the epidemiological profile of injuries due to fall. Materials and Methods: A hospital-based descriptive study was conducted for a period of 1 year starting June 2014. The study population comprised all consecutive cases of injuries due to fall reporting to the Department of Orthopedics during the study except for those who denied consent to be included in the study. Results: Males and age group 26–45 (n = 222/795, 27.9%) are more prone to injuries due to fall. It is seen that out of 795 cases, most of the participants were students (n = 219/795, 27.5%). The common mode of injuries is fall from stairs 16 (13.2%). It is seen that population educated up to middle standard (n = 155/795, 19.5%) or primary level educated (n = 145/795, 18.2%) had higher incidence of fall events. It is observed that fall occurring outside home (n = 535/795, 67.3%) are higher than fall at home (n = 240/795, 30.2%). Conclusions: Falls are an important contributor to injury affecting the productive and otherwise healthy age group of 15–45 years in majority.
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Evaluation of soluble transferrin receptor, soluble transferrin receptor/ferritin ratio, and other iron-related parameters of pregnant women in Cross River State, Nigeria p. 180
Ifeyinwa Maryann Okafor, Atim B Antai, Esien A Usanga
Introduction: Iron is one of the essential trace elements required for hemoglobin synthesis and also for many metabolic processes. Inadequate iron intake can lead to varying degrees of deficiency, from low iron stores to early iron deficiency and iron deficiency anemia and this is dangerous to both fetus and mother. Aim: This study was carried out to assess the levels of soluble transferrin receptor (sTfR), sTfR/serum ferritin (sTfR/SF) ratio, and other iron-related parameters of pregnant women in Cross River State, Nigeria, with the aim to establish reference ranges of these parameters for the population under reference. Materials and Methods: One hundred and seventy apparently healthy pregnant women within the age range of 15 and 45 years attending the antenatal clinics of health-care facilities in Cross River State, Nigeria, were enrolled in this study. The controls consisted of 100 age-matched apparently healthy nonpregnant women from the same environment. Red cell indices were determined using automated blood cell counter. Serum iron and total iron binding capacity (TIBC) were determined using colorimetric method. SF and sTfR were measured using enzyme-linked immunosorbent assay technique. Results: The mean ± standard deviation of the parameters in pregnant woman and in nonpregnant women were serum iron (82.19 ± 3.44), SF (32.15 ± 3.11), transferrin saturation with iron (22.43 ± 11.62), hemoglobin concentration (11.00 ± 0.11), and hematocrit (0.33 ± 0.30). Decreased significantly during pregnancy while TIBC (422.43 ± 19.60), sTfR (3.38 ± 0.41), and sTfR/SF ratio (176.98 ± 396.87) increased significantly in the pregnant women than in nonpregnant women (P < 0.05). The values of serum iron, SF, TIBC, and transferrin saturation were found to show significant variations in the various trimesters of pregnancy. The values of sTfR and sTfR/SF ratio increased significantly (P = 0.01 and P = 001) as trimester increases in our patients. Conclusion: This study reports, for the first time, values for sTfR and sTfR/SF ratio in apparently healthy pregnant women in Cross River State, South-South Nigeria. The study also gives an indication that the use of sTfR and sTfR/SF as a marker in assessing iron status of pregnant women needs to be explored.
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Study of menopausal symptoms in the nursing staff and female attendants in a rural medical college p. 185
Abhilash Sood, Mitasha Singh, Sunil Kumar Raina, AK Bhardwaj, Vishav Chander, Akshay Manhas
Introduction: Menopause is defined as complete cessation of menstruation for 12 months or more. It is characterized by various symptoms such as hot flushes, irritability, sweating, anxiety, and depressive mood. Menopausal symptoms can be assessed by several tools and can be influenced by various sociodemographic factors. The study was planned with the aim to assess the commonly reported menopausal symptoms among women using the Menopause Rating Scale (MRS). Methodology: A cross-sectional study was undertaken at Dr. Rajendra Prasad Government Medical College (DRPGMC) Kangra at Tanda. The study was conducted in the month of November 2013, over a period of 3 weeks. The study population was nursing staff of DRPGMC Tanda and female attendants of patients in the age group 40–60 years. Convenience sampling was used, and the study sample was 200. The psychosomatic, somatic, and urogenital complaints were assessed in this group using the MRS. Results: Two hundred questionnaires were distributed among the nurses and female attendants of whom 180 women responded, a response rate of 90%. 103 of these women had attained menopause. The mean age of study participants was 49.4 ± 4.8 years. The average age of menarche was 14.8 years and mean age of menopause was 45.2 ± 4.7 years. Average MRS score was 11.67 with a maximum score of 31 and minimum score 2. The highest dimensional mean score was 5.48 for the psychosomatic symptoms. Conclusions: Common menopausal symptoms in this study are physical and mental exhaustion, irritability and joint and muscular discomfort.
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Healing effect of Allium sativum on induced upper gastrointestinal tract injury in albino Wistar rats p. 189
Frederick Olusegun Akinbo, Gerald Eze
Background: Peptic ulcer is regarded as a chronic disease that impairs the quality of life and has been linked to increased morbidity and mortality. This study was conducted to determine the ameliorative effect of Allium sativum on induced gastrointestinal tract injury in albino Wistar rats. Materials and Methods: A. sativum was purchased from vegetable market and authenticated in the Department of Pharmacognosis of University of Benin, Benin City, Edo State. A total of 24 albino Wistar rats of both sexes weighing between 120 g and 150 g were used. The rats were randomly shared into six study groups: two control groups and four treated groups (four rats of each). Group A consisted of rats given 1 ml of normal saline and sacrifi ced after 6 h. Group B were rats given 20 mg/kg of indomethacin (n = 4) and sacrifi ced after 6 h. Group C consisted of four rats given 20 mg/kg of indomethacin (n = 4) and treated with aqueous extract of A. sativum (100 mg/kg) body weight, twice daily for 8 days and thereafter sacrificed (n = 4). Group D were given 20 mg/kg of indomethacin (n = 4) and then treated with aqueous extract of A. sativum (200 mg/kg) body weight, twice daily for 8 days and sacrifi ced (n = 4). Group E consisted of four rats given 20 mg/kg of indomethacin (n = 4) and treated with aqueous extract of A. sativum (300 mg/kg) body weight, twice daily for 8 days and sacrifi ced (n = 4). Group F consisted of four rats given 20 mg/kg of indomethacin (n = 4) and afterward treated with cimetidine (50 mg/kg) body weight twice daily for 8 days and sacrificed. Results: A. sativum exhibited better healing activities at 100 mg/kg dosage than 300 mg/kg while cimetidine produced fairly normal mucosa in the stomach and mild mucosa sloughing in the duodenum of the Wistar rats. The 200 mg/kg and the 300 mg/kg doses of A. sativum presented with similar results. Conclusion: Suffice to say that garlic extract is better than cimetidine in the treatment of gastric and duodenal ulcer. Further studies into the antiulcer activity of A. sativum are advocated.
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Comparison of conventional and rapid methods for the detection of methicillin resistance in Staphylococcus aureus from blood cultures p. 196
Ashwani Kumar, Bineeta Kashyap, Anurag Mehndiratta
Background: Considering the increasing rate of infections caused by methicillin-resistant Staphylococcus aureus (MRSA), reliable, accurate, and rapid testing for the detection of MRSA is essential for both initiation of antimicrobial therapy and infection control measures. Materials and Methods: Fifty clinical isolates of S. aureus from patients with bacteremia were confirmed bacteriologically and subjected to antimicrobial susceptibility testing, followed by the detection of methicillin resistance by oxacillin and cefoxitin disc diffusion methods, oxacillin agar screen test, and direct cefoxitin disc diffusion method from blood culture bottles. Results: On comparing the methods under study, 36% MRSA were detected by disc diffusion methods, whereas 44% and 46% were detected by oxacillin agar screen and direct cefoxitin disc diffusion blood culture, respectively. Conclusions: The emergence of MRSA underscores the need for programs to prevent the spread of antimicrobial-resistant organisms and control the use of antimicrobial drugs in health-care settings.
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Congenital ectrodactyly in a macrosomic Nigerian neonate: A case report and review of literature p. 201
Kelechi Kenneth Odinaka, Ikechukwu Frank Ogbonna, Cletus Akahara
Ectrodactyly is a Greek word that literally means abortion of a finger. It is a rare congenital disorder which makes the hands appear like the claws of a lobster. The most common mode of inheritance is autosomal dominant with reduced penetrance although autosomal recessive and X-linked forms of transmission can also occur. Herein, we report a rare case of ectrodactyly in a macrosomic Nigerian male as well as highlight challenges in the management of this genetic condition in a resource-constrained setting.
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Breast dermatofibrosarcoma protuberans in an adolescent male: A case report and extensive review of the literature p. 204
IF Ezejiofor, ME Onwukamuche, D. C. D. Anyiam, JO Ugwu, CO Ndukwe, KC Madubuike, FE Menkiti, CC Ogbu, NS Ozor
Dermatofibrosarcoma protuberans (DFSP) is a nodular cutaneous tumor with high recurrence rate characterized by a prominent storiform pattern. DFSP of the breast is extremely rare and even rarer is DFSP of the male breast. The aim of this article is to present a case report of right breast DFSP (T1N0M0 Stage 1B) in a 13-year-old male. The diagnosis of this case report was based on clinical examination, histology of core, and excisional biopsies as well as immunohistochemistry.
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