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   Table of Contents - Current issue
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July-December 2017
Volume 3 | Issue 2
Page Nos. 71-140

Online since Monday, January 8, 2018

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EDITORIAL  

Guidelines for conduct of journal club for postgraduates: A tool for evidence-based medicine Highly accessed article p. 71
Kurien Thomas
DOI:10.4103/jcrsm.jcrsm_63_17  
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REVIEW ARTICLE Top

Biofilm formation as a virulence factor of Acinetobacter baumannii: An emerging pathogen in critical care units p. 74
A Arockia Amala Reena, Anandhalakshmi Subramaniyan, Reba Kanungo
DOI:10.4103/jcrsm.jcrsm_66_17  
Acinetobacter baumannii, an emerging nosocomial pathogen, is increasingly associated with serious infections among hospitalized patients, especially those on life-support systems. A. baumannii has become resistant to almost all currently available antibacterial agents, including carbapenems, which were once considered the drug of choice for the treatment of infections with multidrug-resistant (MDR) organisms. A. baumannii is notorious in its ability to spread among hospitalized patients and causes outbreaks which have been reported worldwide. The capability of these strains to circulate widely seems to depend on the expression of virulence factors that allow bacterial colonization as well as on the expression of antibiotic resistance. Biofilm production by A. baumannii appears to be one of the major contributing factors in colonization, notably of medical devices. This review explores published literature on the association of biofilms and MDR A. baumannii in hospitalized patients. An online search was made for articles of original work and reviews on biofilms production among Acinetobacter and their association with virulence. The articles were reviewed and results were analyzed based on biofilm production and the factors associated with it, namely biofilm cycle, biofilm-associated protein, chaperone-usher secretion system, and quorum sensing.
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ORIGINAL ARTICLES Top

Diagnostic accuracy of neutrophil to lymphocyte ratio in prediction of nonsevere preeclampsia and severe preeclampsia p. 79
Rekha Sachan, Munna Lal Patel, Vandana , Pushplata Sachan, Radhey Shyam
DOI:10.4103/jcrsm.jcrsm_27_17  
Background: Preeclampsia (PE) is a pregnancy specific syndrome characterized by hypertension and proteinuria after 20 weeks of gestation. There is inadequate placentation due to a deficiency in trophoblastic invasion which causes placental hypoxia leading to pro-inflammatory cytokine secretion, neutrophil activation, and endothelial dysfunction. Material and Methods: This prospective case–control study was carried out over a period of 1 year after informed consent and ethical clearance. Total 543 pregnant women were recruited and 43 women were lost to follow up, so 500 pregnant women followed upto 6 weeks after delivery. Out of these 51 women developed hypertensive disorders of pregnancy. 1 subject excluded during analysis since she developed Eclampsia. Thus study comprised of total 50 cases [Group 1(nonsevere PE)-34 cases and Group 2 (severe PE)-16 cases] and 51 healthy pregnant women who were controls. 5 ml venous blood samples were obtained from all the cases and controls. Samples were collected 2 times; first during the enrollment and second sample was collected after the development of disease. Neutrophil, and lymphocyte levels were measured by Medonic M 20, automated cell counter which gives the reading of cell counts, when microlitres of blood pass through it, NL ratio was obtained after reading. Results: Those women who developed PE during follow-up (Groups 1 and 2) had higher neutrophil to lymphocyte ratio (NLR) than that of the healthy pregnant women even at early gestation. The receiver operating curve showed significant diagnostic accuracy of NLR between controls and nonsevere PE (NSPE) cases (area under the curve [AUC] = 0.75, P = 0.01) at cutoff value of >3.35%, 52.9% sensitivity, and 74.5% specificity. It also showed significant diagnostic accuracy (AUC = 0.894, P = 0.005) between NSPE and severe PE, at a cutoff value of 3.42 with a sensitivity of 81.3% and specificity of 64.7%. Conclusion: NLR is a promising marker for the prediction of PE and in the detection of severe PE too.
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Evaluation of antidiabetic property of quail egg on alloxan-induced diabetes mellitus in Wistar albino rats p. 84
Amarachi Agbafor, David Arome, Wilson Goodness Oluebube
DOI:10.4103/jcrsm.jcrsm_32_17  
Background: Alloxan-induced hyperglycemia has been a useful experimental model to study activity of hypoglycemic agents. Alloxan has been utilized in the diabetes model due to its ability to produce a high percentage of the endogenous beta cells destruction. Objective: The principal objective of the study was to evaluate the antidiabetic property of quail egg on alloxan-induced diabetes in Wistar albino rats. Materials and Methods: Freshly, prepared quail egg of 0.5, 1.0, and 1.5 ml and reference standard drug of metformin 10 mg/kg were used in the study, administered through oral route. The antidiabetic property of the quail egg was evaluated using alloxan-induced diabetes in Wistar albino model. Results: The quail egg-treated groups (1.0 and 1.5 ml) exhibited considerable significant (P < 0.05) antidiabetic property with drastic reduction in the blood glucose level. There was a significant reduction in the blood glucose levels in the quail egg-treated groups at day 7 and 14, respectively. The quail egg-treated group of 1.5 ml showed better antidiabetic activity characterized with a significant reduction of blood glucose level compared to the positive group which received the standard reference drug metformin monohydrate 10 mg/kg. Conclusion: The research findings of the study clearly showed that quail egg possesses an antidiabetic property.
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Antimicrobial activity of Vitamin C demonstrated on uropathogenic Escherichia coli and Klebsiella pneumoniae p. 88
Rohan Jacob Verghese, Stephen K Mathew, Alice David
DOI:10.4103/jcrsm.jcrsm_35_17  
Purpose: Studies have demonstrated the ability of Vitamin C (ascorbic acid) to inhibit pathogenic bacteria and inhibit biofilms. The effect of varying concentrations of ascorbic acid on bacterial growth was studied on uropathogenic Escherichia coli and Klebsiella pneumoniae. The concentration at which maximal inhibition occurred was determined. Methods: All uropathogenic strains of E. coli and K. pneumoniae isolated from patients over a 3-month period were incubated in varying concentrations (5, 10 and 20 mg/ml) of Vitamin C-supplemented Trypticase Soy Broth. Effect on bacterial growth was quantified as a change in absorbance measured by spectrophotometry (450 nm), as compared to controls. Independent samples t-test was used to calculate P value. Results: Bacterial growth was inhibited at all Vitamin C concentrations. Mean absorbances of E. coli and K. pneumoniae broths containing 5, 10, and 20 mg/ml Vitamin C were significantly less than absorbances of growth control broths without Vitamin C (P < 0.005). This inhibition was independent of antimicrobial resistance profiles of isolates. Differences between mean absorbance at 10 and 20 mg/ml Vitamin C for both species were not significant (P > 0.005). Thus, the inhibitory activity of Vitamin C appears to be dose-dependent, with 10 mg/ml being the optimum concentration of ascorbic acid. Conclusions: Ascorbic acid's ability to inhibit bacterial growth may find novel clinical applications. Vitamin C may find potential use in topical antibacterial applications, or urinary bladder irrigation fluid for catheterized patients with urinary tract infections or during bladder instrumentation. There is a need to further explore the possibility of using Vitamin C safely as an effective antimicrobial agent.
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Needlestick, sharp, and splash injuries in a tertiary care government hospital of South India p. 94
Apurba Sankar Sastry, Deepashree Rajshekhar, Prasanna Bhat
DOI:10.4103/jcrsm.jcrsm_42_17  
Background: Needlestick, sharp, and splash injuries (NSSSIs) are the major occupational hazards among the healthcare workers (HCWs) for blood-borne viruses (BBVs) such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). This study was designed to determine the impact of an established nodal center for NSSSI management and to analyze the epidemiological characteristics. Materials and Methods: Dedicated nodal center was established for NSSSI documentation. A standard operating protocol was set for NSSSI management and postexposure prophylaxis (PEP) for BBVs. The epidemiological characteristics of NSSSIs were collected using a structured pro forma. Results: Between December 2014 and November 2016, 452 NSSSIs were reported, which included 411 (90.9%) needlestick and other sharp injuries and 41 (9.1%) splash injuries. Doctors reported the maximum episodes (32.5%), followed by attenders (28.8%) and nurses (21.9%). Most injuries were contracted during device use (44.8%), followed by after withdrawal before disposing (28.5%) and recapping (14.8%). Increased reporting was observed among newly-joined junior doctors. 6.9% of source was positive for BBVs (1.8% HIV; 4.0% HBV; 1.1% HCV). PEP first dose was taken by 30.5% of HCWs. PEP continuation was indicated in 161 cases but could not be traced. 40.9% HCWs were completely vaccinated for HBV (of which 49.2% are protected), 7.1% were partially, and 52.0% were not vaccinated. Conclusion: Our findings endorse the essential role of an established nodal center for NSSSI documentation. Continuous education, engineering control, vaccination campaign, and other interventional strategies such as biomedical waste auditing are crucial measures which should be taken to tackle this issue.
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Perspectives on poster as a presentation mode in conferences Highly accessed article p. 102
Himel Mondal, Shaikat Mondal
DOI:10.4103/jcrsm.jcrsm_58_17  
Background: Research knowledge is dispersed among peers commonly via three modes of presentation in conferences – workshop, oral presentation, and poster presentation. Each mode of presentation has certain advantages and disadvantages. Aim: The aim of this study was to explore medical professionals' perspectives on advantages and disadvantages of poster presentation in scientific conferences. Materials and Methods: A pretested questionnaire was used as the survey instrument. The instrument was composed of eight statements with 5-point Likert-type response option. A cross-sectional, online survey (on Google Forms) was conducted among medical professionals who participated in conferences where posters were presented for research presentation. Responses were expressed in percentages and compared by Chi-square test with α = 0.05. Results: Survey response rate was 29.06% ([247/850] × 100). The best feature of poster presentation was the option to re-read the paper (98.78%) followed by the facility of face-to-face interaction with authors (95.15%) and facility to read the paper of interest only (93.12%). Highest equivocal opinion was received (42.92%) for applicability of poster in presentation of in-depth information about the research. Conclusion: This study revealed that preference of poster presentation is mostly due to facility of reading the paper of interest only and option to re-read according to necessity. Face-to-face interaction with researcher was another major advantage of poster as a presentation medium. Hence, an option for presenting oral papers as posters, presented by a coauthor, may be considered for wide dispersion of research knowledge.
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CASE REPORTS Top

Dapsone-induced methemoglobinemia leading to nystagmus p. 107
Ranvijay Singh, Mukti Gandhi, Maryam Naveed, Gauri Shailesh Pikale
DOI:10.4103/jcrsm.jcrsm_31_17  
Dapsone, classified as a sulfonamide antibiotic, has been found to be useful in an array of infectious as well as inflammatory diseases. Neuropathy, agranulocytosis, hypersensitivity, methemoglobinemia, hemolysis, and jaundice are the most common potential side effects of dapsone when taken at high doses. We present a case report of an extremely rare side effect of dapsone overdose in a man due to accidental ingestion, resulting in methemoglobinemia associated with bilateral gaze evoked horizontal nystagmus. The patient was taking dapsone for the treatment of leprosy. Methemoglobinemia is a known side effect of dapsone therapy; nystagmus is rarely seen in dapsone overdose. The patient recovered completely after receiving treatment with multiple drugs and had no nystagmus, implying that dapsone-induced nystagmus is reversible in nature. Dapsone is a drug that has potent anti-inflammatory, antiparasitic, and antibacterial properties and it has found to be useful in the treatment of multiple diseases. The purpose of documenting this case report is to bring to the attention of physicians and others involved in patient care the serious side effects of dapsone.
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Connective tissue: A gold standard for reconstruction of black triangle p. 111
Anamika Sharma, Vineeta Singal
DOI:10.4103/jcrsm.jcrsm_41_17  
Esthetic awareness has improved vastly in the last decade. Periodontal plastic surgery has made it possible to correct or eliminate anatomic, developmental, or traumatic deformities of the gingiva or alveolar mucosa. However, till date, the most challenging scenario lies in the enhancement of lost interdental papillae in the maxillary anterior region. An open gingival embrasure or black triangle occurs as a result of a deficiency of papilla beneath the contact point, which causes complex esthetic and functional problems. Several reasons contribute to the loss of interdental papillae, and various surgical and nonsurgical techniques for papillary reconstruction have been proposed till now. The present article describes a case of papilla reconstruction procedure using connective tissue graft. The procedure resulted in nearly 100% fill of the interproximal embrasure.
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A case of cardiac arrest during insertion of an epidural needle and before the administration of any epidural medication p. 115
Ramyavel Thangavelu, Arish Tangaponnu Bacthavassalame, Ranjan Ripponpete Venkatesh, Sagiev Koshy George
DOI:10.4103/jcrsm.jcrsm_50_17  
Cardiac arrest following regional anesthesia is a relatively common and often a grave complication. A number of cases have been reported in literary sciences. Here, we report a case of 28-year-old young adult female posted for femur nailing surgery who sustained a cardiac arrest on insertion of epidural needle even before epidural catheter could be secured or any epidural medication was administered. Fortunately, she was successfully resuscitated with timely and appropriate cardiopulmonary resuscitative efforts. Here, we consider excess vagal activity associated with excess anxiety to be the probable cause of syncope and hypoxia leading to tachyarrhythmia and finally culminating to cardiac arrest. The present case report would probably allow us to explore the possible causes of such an unusual and possibly an avoidable event. Careful preoperative assessment of patient anxiety level, reassurance, good sedative premedication, alternate positioning for regional technique, and finally close monitoring and prompt intervention would definitely improve outcomes.
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Irritation fibroma: Report of a case p. 118
Gazal Jain, Ritika Arora, Anamika Sharma, Rashmi Singh, Mrinalini Agarwal
DOI:10.4103/jcrsm.jcrsm_53_17  
Traumatic or irritation fibroma is the healed end product of the inflammatory hyperplastic lesion which can occur at any age from almost any soft-tissue site, tongue, gingiva, and buccal mucosa being the most common. The aim of this case report is to present the clinical features and management of the benign lesion which was posteriorly positioned in the interdental papillary region of mandibular premolars. A female patient, 40 years old, reported to the department with a chief complaint of pain and swelling in the right lower back tooth region for the past 1 year. On examination, the lesion was found to be a well circumscribed, smooth, tender, firm and lobulated pink swelling measuring 2 cm × 2 cm in its greatest diameter in relation to right mandibular premolar region. Surgical therapy was carried out for the management of the same. There was no recurrence reported at the end of 2 months showing that treatment with electrocautery was highly effective as it was a relatively simple and safe method with easy handling of the electrodes without any bleeding or scarring. Irritation fibroma clinically resembles as pyogenic granuloma, peripheral giant cell granuloma, or odontogenic tumors, so radiographic and histopathological examination is essential for accurate diagnosis. Furthermore, complete excision is the choice of treatment as recurrence has been associated with incomplete removal of the lesion.
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A surprise during hypospadias repair: A rare case of urethral duplication with review of literature p. 122
Aju James Ashok, Mamatha Basavaraju, Ninan Zachariah, SK Pavithra
DOI:10.4103/jcrsm.jcrsm_57_17  
Urethral duplication (UD) is a rare congenital anomaly mainly affecting boys. This article highlights a case of UD which was incidentally diagnosed during hypospadias repair. It was an incomplete UD with an accessory channel opening orthotopically and primary urethral opening being hypospadiac. The patient underwent glansplasty and excision of distal septum between the two urethrae to make it into a single channel following which he was asymptomatic.
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Application of the induced membrane technique for treatment of diaphyseal bone defect secondary to osteomyelitis of ulna: A modified approach p. 125
Shishir Murugharaj Suranigi, Abey Thomas Babu, Sundara Ravi Pandian, Anita Ramdas, Syed Najimudeen
DOI:10.4103/jcrsm.jcrsm_59_17  
Induced membrane technique has gained wide popularity since it was first described by Alain C Masquelet in the year 2000. Before the advent of this procedure, the vascularized bone free transfer and the Ilizarov bone transport method were the only two salvage methods which produced satisfactory results in cases of wide long bone diaphyseal defects. The classical Masquelet technique described, involves the use of cancellous bone graft in a biological membrane, which is induced after placing polymethylmethacrylate (PMMA) cement that allows the formation of new bone. We report a case of a 21-year-old girl who had chronic osteomyelitis of ulna resulting in a segmental bony defect of 8 cm treated by modified Masquelet technique. Instead of using only the cancellous graft, we used a combination of fibular strut graft with iliac cancellous graft to reduce the period of morbidity and increase the chances of union. Radiographs done at 3 month-follow-up showed good integration of the graft on either end of the fibula strut graft. Patient had an excellent functional and radiological outcome. The modified-induced membrane technique for the treatment of posttraumatic osteomyelitis of the ulna is a simple, reliable method, with good early results.
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LETTERS TO EDITOR Top

Epistemics – The under-emphasized factor in self-directed learning p. 129
V Dinesh Kumar
DOI:10.4103/jcrsm.jcrsm_22_17  
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Role of quantitative diffusion-weighted magnetic resonance imaging in differentiating benign and malignant thyroid lesions p. 131
Reddy Ravikanth, Robert Patrick Selvam, Denver Steven Pinto
DOI:10.4103/jcrsm.jcrsm_34_17  
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Qualitative research: The philosophy behind the road less taken p. 134
V Dinesh Kumar
DOI:10.4103/jcrsm.jcrsm_23_17  
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COMMENTARY Top

Novel insight on probiotic Bacillus subtilis: Mechanism of action and clinical applications p. 136
Manoj A Suva, Varun P Sureja, Dharmesh B Kheni
DOI:10.4103/jcrsm.jcrsm_47_17  
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LETTERS TO EDITOR Top

The blue whale challenge: Why do people commit suicide for an online game? p. 137
Parthasarathy Ramamurthy
DOI:10.4103/jcrsm.jcrsm_49_17  
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Force field analysis: An effective tool in qualitative research p. 139
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/jcrsm.jcrsm_55_17  
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