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   Table of Contents - Current issue
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January-June 2018
Volume 4 | Issue 1
Page Nos. 1-72

Online since Friday, May 25, 2018

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EDITORIAL  

Rationalizing antibiotic use through a robust policy, antibiotic stewardship, and pharmacokinetic-pharmacodynamic principles Highly accessed article p. 1
Reba Kanungo
DOI:10.4103/jcrsm.jcrsm_8_18  
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REVIEW ARTICLE Top

Understanding the central tenet and plausible consequences of oxidative DNA damage in the male gamete p. 3
V Dinesh Kumar
DOI:10.4103/jcrsm.jcrsm_46_17  
One of the major causes of defective sperm function is sperm DNA damage induced by oxidative stress. The quasicrystalline state of sperm chromatin and lack of cytoplasm make it vulnerable to DNA damage induced by oxidative attack. Supraphysiological levels of reactive oxygen species result in damage to sperm DNA and therefore might provide a common underlying etiology of male infertility and recurrent pregnancy loss, in addition to childhood cancers in children fathered by men with defective sperm cells. This review aims to throw light on the causative links between oxidative stress and sperm DNA damage. Integral to this discussion is an abundance of evidence indicating that sperm DNA damage might have a profound impact in determining the outcome of assisted reproductive technologies (ARTs). Despite a growing body of evidence, routine testing for oxidative stress is not indicated in clinical practice. This calls for cost-effective, accurate, and simple diagnostic tools that can be routinely used when evaluating men with idiopathic infertility. Encouragingly, the involvement of oxidative stress in the etiology of male infertility has opened up new opportunities for therapeutic interventions involving judicious administration of antioxidants. The topic is of paramount importance in the current scenario where extensive use of ART achieves pregnancies in vitro which would have been prevented in vivo by nature, ensuring that the defective gametes not participating in generative process.
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ORIGINAL ARTICLES Top

Comparing the efficacy of visual inspection of cervix with acetic acid and Lugol's iodine with Pap smear cytology in screening for cancer cervix p. 10
Snehil Sinha, Vinita Singh, Byasdev Mishra, Anu Singh
DOI:10.4103/jcrsm.jcrsm_40_17  
Background: Cervical cancer, despite being a preventable disease endangers the lives of significant number of women every year and also its incidence is growing with time. Cervical cytology which is a well-accepted standard screening tool in developed countries but in developing countries like India it fails not only due to the lack of awareness but also due to financial and technical constraints. Visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI) have been evaluated in a number of large clinical trials and is considered to be a possible alternative to cervical cytology for primary cervical cancer screening in low-resource settings. Aim of the Study: (1) The aim of the present study was to compare the efficacy of VIA and Lugol's iodine with Pap smear cytology in screening for cancer cervix and evaluate their usefulness as tools for screening of premalignant and malignant lesions of cervix so that VIA can be used in peripheral areas where cytology is not available. (2) Early detection of pre-cancerous conditions and treating them before they progress to invasive cancer. Methodology: This clinical study was conducted on 200 gynecological patients who were nonpregnant or who had no history suggestive of cervical intraepithelial neoplasia or carcinoma cervix. After taking informed and written consent each woman who fulfilled the inclusion criteria were subjected to Pap smear examination, VIA and VILI. A biopsy was taken in patients with abnormal findings or suspicious findings on VIA/VILI. Results: In the present study, the sensitivity of VIA and VILI was 88.23%, specificity 78.68%, positive predictive value was 53.57%, and negative predictive value was 96% with biopsy as the reference standard. The sensitivity and specificity of cytology in our study were 88% and 52.63%, respectively. Conclusion: VIA and VILI are simple, inexpensive, and low-technology test. Both when combined have high sensitivity as well as specificity. This can be practiced by clinicians and paramedics on a wide scale. Another advantage is immediate availability of results and hence that treatment can be started during the same visit.
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Ultrasound evaluation of cervical length in the second trimester of pregnancy: The impact of cesarean section and ethnicity p. 17
Moawia Gameraddin
DOI:10.4103/jcrsm.jcrsm_69_17  
Background and Objective: The sonographic assessment of cervical length (CL) is an important part of ultrasound evaluation in the second trimester of pregnancy. There are specific maternal characteristics and obstetric history which affect the CL. This study aims to assess the influence of mode of delivery and ethnicity on the CL in women with divergent ethnicity. Materials and Methods: A prospective cross-sectional study was designed, including 109 pregnant Sudanese women in the second trimester. They were investigated with transvaginal ultrasonography (TVS) using high-frequency 7.5-MHz probe to assess the CL. The participants were categorized according to their ethnicity and regions. The results were analyzed using analysis of variance (ANOVA) and Student's independent t-test in the SPSS program version 16 (IBM Inc.) and P > 0.05 considered to be statistically significant. Results: The mean TVS CL was 38.2 mm in the second trimester of pregnancy. The CL of northern Sudanese women was significantly longer than women from western, southern and eastern Sudan (P = 0.041). The mean CL of previous cesarean-sectioned women was 37.7 mm which was statistically significantly shorter than those who delivered normally (P = 0.03). The CL was not significantly different in multiparous compared to nulliparous women (37.83 vs. 37.78 mm, P= 0.77). Maternal age and gestational age did not significantly change the CL in second and third trimesters, P= 0.69 and 0.99, respectively. Conclusions: In the light of this study, cesarean section and ethnicity were considered to be significant factors that affect the CL in the second trimester of pregnancy. We suggest transvaginal sonographic measurement of CL as a part of a routine ultrasound evaluation in the second trimester.
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Awareness of prenatal sex determination and preconception and prenatal diagnostic techniques act: A comparative study among rural and urban females of reproductive age group (15–45 years) attending a tertiary care teaching hospital in North India p. 21
Rajiv Kumar Gupta, Bhavna Langer, Parveen Singh, Sunil Kumar Raina, Rashmi Kumari, Shahid Hussain, Riya Gupta
DOI:10.4103/jcrsm.jcrsm_43_17  
Background: Preference for a male child by the family leading to a sex-selective abortion has been a leading factor for the skewed sex ratio in India. This has long-term social and demographic consequences. The present study was conducted with the aim to assess the awareness and attitudes regarding prenatal sex determination and preconception and prenatal diagnostic technique act (PC-PNDT) among females of reproductive age group (15–45 years) attending a tertiary care teaching hospital in Jammu district of J and K state in North India. Materials and Methods: A hospital-based cross-sectional study was carried out among 210 females of reproductive age group. The study participants were administered a predesigned and pretested questionnaire. Data thus obtained were analyzed using SPSS Version 20.0 and expressed in percentages. Chi-square test was used as test of statistical significance with P < 0.05 taken as statistically significant. Results: Awareness about sex determination among respondents was 94%. Higher proportion of urban respondents knew about ultrasound as the technique for sex determination than their rural counterparts (P < 0.05). Awareness regarding the PC-PNDT act and determination of sex of a child being a crime was higher among urban respondents (P < 0.05). Among the attitude, more rural females would prefer to know the sex of the child (P < 0.05) than their urban counterparts. Conclusion: Respondents had high awareness about sex determination as well as technique used for it. Awareness about PC-PNDT act was on the lower side. Education programs for the women about gender equality and wider publicity of the act in the mass media need to be scaled up.
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An observational study for assessment of point-of-care management received by diabetic patients before referral to a tertiary care hospital p. 26
Gouranga Santra
DOI:10.4103/jcrsm.jcrsm_65_17  
Introduction: Quality of diabetes care is suboptimal worldwide and it varies in rural and urban areas. Indian studies assessing the quality of diabetic care are few. We conducted a study to identify the gap in diabetes management as rural patients received before referral to a tertiary care hospital. Methods: The study was conducted over 2 years in our institution. Rural patients managed previously outside our institution were included in the study. Patients were interviewed for treatment history. Prescriptions and related documents were evaluated for basic examinations, investigations, proper advices, and management processes. Results: A total of 352 diabetic patients were evaluated. Blood pressure (BP) checkup was more regular than blood sugar monitoring (91% vs. 58%). Glycosylated hemoglobin was monitored rarely (2%). Eye checkup (2%), screening of neuropathies (7%), autonomic features (3%), electrocardiography (11%), and lipid screening (9%) were infrequent. Urine microalbumin-creatinine ratio was checked rarely (1%). Advice on diet (62%), exercise (56%), smoking cessation (15%), and foot care (2%) were suboptimal. Usages of insulin, oral hypoglycemic agents (OHA), and antihypertensive agents were suboptimal. Only 86 cases (29%) out of 295 with indications of OHA got adequate dose of OHAs and only 5 cases (9%) out of 57 cases with indications of insulin got adequate dose of insulin. Among diabetic hypertensives (115 cases), only 19% got adequate dose of antihypertensives. Conclusion: Diabetic patients were managed inadequately. The study provides data for developing interventions for improving the quality of diabetes care of rural patients outside the tertiary care setup.
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Awareness of treatment options for dengue fever among the patients and their relatives attending a tertiary care hospital in central Kerala p. 30
Jency Maria Koshy, Alice David, SK Mathew, Mohan Varughese, Sony Punnen Thomas, Jibin John Thomas
DOI:10.4103/jcrsm.jcrsm_67_17  
Introduction: Dengue virus infection is a major cause of morbidity, mortality, and economic hardship in the tropics and subtropics. We undertook this study to see the level of awareness of symptoms and the treatment options for dengue fever. Materials and Methods: This was a cross-sectional study done in the Department of Medicine at a tertiary medical care in central Kerala during July 2017. The patients and their attendants visiting outpatient department were interviewed by trained social workers after taking a written consent. The interview was conducted based on a structured questionnaire. Distribution of various aspects of awareness and sociodemographic characteristics are presented. The association of the awareness of treatment options with sociodemographic characteristics was estimated. Results: Among the 522 subjects interviewed 509 (97.51%) had heard about dengue. Majority of them (89.59%) were aware that this is a preventable disease. Newspaper (80.94%) and television (74.85%) were the main sources of information. Most (85.85%) of them were aware of the infectious nature of the disease and that mosquitoes are the responsible vector. The most common symptoms of this disease which they were aware of were fever (64.83%), body ache (62.48%) and headache (50.68%). Almost half (48.13%) of them incorrectly expressed the need for antibiotics for this viral illness and 46.37% felt the need for platelet transfusion to hasten the recovery. Only education was associated with better awareness regarding antibiotic use (odds ratio [OR] [95% confidence interval [CI]: 1.55 [1.03–2.34]) and platelet transfusion (OR [95% CI]: 2.40 [1.17–4.91]). Conclusions: They had a reasonably good awareness of the vector that promotes dengue and its breeding sites. However, there were misconceptions regarding the treatment options.
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Impact of a spaced learning initiative in an undergraduate student teaching program in pediatrics p. 37
Peter Prasanth Kumar Kommu, Soumendra Sahoo, Anil Kapoor, Anu Sharma, Vimala Thomas
DOI:10.4103/jcrsm.jcrsm_52_17  
Objective: The purpose of this study is to assess the impact of spaced learning in an undergraduate teaching and learning program in pediatrics. Methodology: Analytical study involving the final year medical students posted in the Department of Pediatrics. “Spaced” learning opportunities were provided in addition to the conventional didactic lectures over 8 weeks for the assigned topics. The scores obtained before and after the spaced learning were analyzed using “t”-test. Results: A total of 37 students who underwent the spaced learning initiative and participated in both the tests (before and after spaced learning) were included in the analysis. There was significant positive correlation between the scores of the two groups r = 0.526 (P < 0.001). Paired sample “t”-test showed that there was a statistically significant difference between the test scores with a mean of 11.23, t = 7.434 (P < 0.001). Conclusion: Spaced learning had a significant impact on the students in their learning and recall, leading to better performance in their examination.
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Effect of Ferula assa foetida oleo-gum-resin on gastric ulcer in indomethacin-ulcerated rats p. 42
Seyyed Majid Bagheri, Maryam Yadegari, Fatemeh Zare-Mohazabiye, Hanieh Momeni-Asl, Aghdas Mirjalili, Morteza Anvari, Malihe Behpour
DOI:10.4103/jcrsm.jcrsm_48_17  
Background: Asafoetida is used as an antiulcer agent in Iran and Afghanistan. This study was undertaken to determine the healing of ulcers induced by indomethacin (IND) due to the protective role of asafoetida on ulcers in rats. Materials and Methods: Rats were divided into four groups with five rats in each group. One group only received IND as negative control group and other group received normal saline and considered as control group, respectively. Two groups were pretreated by asafoetida (25 and 50 mg/kg) by oral gavage for 4 days, and after this time, rats were kept fasted for 12 h and received IND at 48 mg/kg orally. Four hour later, animals were killed and their stomach and liver were fixed in formalin (10%) and sections of 5 μm in diameter were prepared. Histological and morphological characteristics of stomach and liver were assessed using hematoxylin and eosin (H and E) staining. Results: Treatment groups with asafoetida (25 and 50 mg/kg) showed significant (P < 0.05) reduction in microscopic and macroscopic ulcer index as compared to the IND control group. Asafoetida promotes ulcer protection as ascertained histologically by comparatively decrease in ulcer areas, reduction or absence of edema and leukocytes infiltration of submucosal layer compared to IND control group. The results also indicated that asafoetida has a protective effect on liver tissues. In general, ameliorative effects of asafoetida in animals treated at 50 mg/kg were better than dose of 25 mg/kg, respectively. Conclusions: Data indicates that asafoetida has anti-ulcer and hepatoprotective activity that these beneficial effects may be or mainly related to anticholinergic antihistaminergic and antioxidant effects.
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Knowledge and practices about animal bite management among government doctors posted at primary health-care settings of district Patiala in Punjab p. 47
Vishal Malhotra, Amarjit Singh, Rajinder Singh Balgir
DOI:10.4103/jcrsm.jcrsm_64_17  
Background: Approximately 36% of the world's rabies deaths occur in India, three-fourth of them in rural areas. Out-of-pocket expenses and lack of transportation from rural areas prevent many of the poorest people in India from accessing primary health-care services, leaving them to carry the burden of rabies. Rabies incidence in India has been constant for a decade, without any obvious declining trend, this situation is due to general lack of awareness of preventive measures, which includes insufficient dog vaccination, an uncontrolled canine population, poor knowledge of proper post-exposure prophylaxis on the part of many medical professionals, and an irregular supply of antirabies vaccine and immunoglobulin, particularly in primary-health-care facilities. The present study was done to assess the skill and knowledge about animal bite management among primary health care providers health-care providers at peripheral health institutes of district Patiala. Materials and Methods: A cross-sectional survey was done using pretested and validated, self-administered questionnaire. Overall awareness was assessed based of sum score of each outcome according to blooms cutoff point, P < 0.05 was considered statistically significant. Results: Out of 103 government doctors, rural medical officers (RMOs) constitute 32 (31%) and Punjab civil medical services (PCMS) 71 (69%). RMO Cadre has more mean age (34.06 ± 3.95), than PCMS (29.02 ± 5.98). Both cadres have many gaps in their knowledge. Median score of both groups is 13. Almost 45% have low knowledge-practice (K-P) score and the difference in K-P score of RMOS and PCMS are not statistically significant. Conclusion: Both groups lack knowledge on how to manage common clinical scenarios frequently seen in rural areas. There is urgent need for upgrading the knowledge and skills of doctors working at the peripheral health facilities. State health department must coordinate with medical colleges for training by organizing continued medical education for the success of national rabies control programme.
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Antihyperlipidemic activity of Hridayarnava Rasa (an Ayurvedic herbo-metalo-mineral formulation) in Charles Foster albino rats p. 52
Swapnil Y Chaudhari, Mukesh B Nariya, Galib Ruknuddin, Pradeep Kumar Prajapati, Jayram Hazra
DOI:10.4103/jcrsm.jcrsm_68_17  
Background: Hyperlipidemia is modifiable risk factor for cardiovascular diseases, and its prevalence is alarmingly increased in India. Although many treatment modalities are effectively used in the conventional system, they have certain limitations and adverse effects. Ayurvedic metallic and herbo-mineral formulations are safely practiced in Indian subcontinent without any noticeable side effects. Hridayarnava Rasa is one such Ayurvedic herbo-metalo-mineral formulation containing Tamra Bhasma (incinerated copper) as an integral component that is being successfully prescribed in the management of lipid disorders. Materials and Methods: Tamra Bhasma is prepared with different Amritikarana methods which are said to eliminate all the blemishes from the end product and increases its therapeutic efficacy. The antihyperlipidemic activity of Hridayarnava Rasa prepared from Tamra Bhasma processed in Panchamrita (HRTBP) was carried out in Charles Foster albino rats having hyperlipidemia induced by high-fat diet. The parameters including body weight, organ weight, serum lipid profile, and histopathology of liver, heart, kidney, and aorta were studied. Results and Coclusion: Results revealed that HRTBP attenuated increased lipid profile and pathological changes in heart, liver, and kidney induced by administration of hyperlipidemic diet. Hridayarnava Rasa has shown mild antihyperlipidemic activity in experimental animals. Background: Hyperlipidemia is modifiable risk factor for cardiovascular diseases, and its prevalence is alarmingly increased in India. Although many treatment modalities are effectively used in the conventional system, they have certain limitations and adverse effects. Ayurvedic metallic and herbo-mineral formulations are safely practiced in Indian subcontinent without any noticeable side effects. Hridayarnava Rasa is one such Ayurvedic herbo-metalo-mineral formulation containing Tamra Bhasma (incinerated copper) as an integral component that is being successfully prescribed in the management of lipid disorders. Materials and Methods: Tamra Bhasma is prepared with different Amritikarana methods which are said to eliminate all the blemishes from the end product and increases its therapeutic efficacy. The antihyperlipidemic activity of Hridayarnava Rasa prepared from Tamra Bhasma processed in Panchamrita (HRTBP) was carried out in Charles Foster albino rats having hyperlipidemia induced by high-fat diet. The parameters including body weight, organ weight, serum lipid profile, and histopathology of liver, heart, kidney, and aorta were studied. Results and Coclusion: Results revealed that HRTBP attenuated increased lipid profile and pathological changes in heart, liver, and kidney induced by administration of hyperlipidemic diet. Hridayarnava Rasa has shown mild antihyperlipidemic activity in experimental animals.
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CASE REPORTS Top

Duodenocutaneous fistula: An innovative management with triple tube drainage p. 58
Nirmal Kumar Palaniappan, Jacob Jayakar Raju Mandapati, Thangiah Gurusamy
DOI:10.4103/jcrsm.jcrsm_51_17  
Treatment of duodenocutaneous fistula is an expensive and time-consuming proposition, but in the absence of complicating factors, 74% of these fistulas close over a 9–12-week period of time. When complicated with sepsis, distal obstruction, and biliary peritonitis, the cost of treatment and length of hospital stay are increased along with high mortality associated with it. We present a patient who was reoperated with a technique using 3 tube (gastrostomy, duodenostomy, and feeding jejunostomy) which enhanced his recovery and speedy discharge from hospital at a lesser cost compared to traditional methods of treatment. Managing high output enterocutaneous fistula is difficult. Our technique ameliorates the nutrition, improves the fluid and electrolyte balance, decreases the morbidity, and evades the mortality when compared to existing management methods in literature.
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Mediastinal pseudocyst clinically presenting as mechanical dysphagia and dyspnea in a case of acute-on-chronic pancreatitis p. 62
Reddy Ravikanth, Partha Sarathi Sarkar, Alok Kale
DOI:10.4103/jcrsm.jcrsm_61_17  
Pseudocyst is a common complication of acute pancreatitis. However, its extension into the mediastinum is a rare entity. Contrast-enhanced computed tomography has a very high sensitivity in providing the location and anatomical relation of the pseudocyst to the surrounding structures. Here, we present a rare case of pancreatic pseudocyst in the mediastinum presenting clinically with dysphagia and dyspnea.
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Nasojejunal tube in the treatment of enterocutaneous fistula: A blessing in disguise p. 65
Jacob Jayakar Raju Mandapati, Thomas Alexander
DOI:10.4103/jcrsm.jcrsm_45_17  
We present a patient who developed a jejunocutaneous fistula following jejunal resection, in whom a nasojejunal tube was placed with the tip distal to the fistula. Although the primary purpose of placing the tube was for feeding, the output from the fistula that was averaging 600 ml/day, stopped completely on the day after the tube was placed and the wound healed within 10 days. In this report, the role of a nasojejunal tube in functioning as an internal scaffold to facilitate closure of an enterocutaneous fistula is highlighted.
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Rare case of atypical intraparenchymal epidermoid cyst p. 68
Nagarjun Maulyavantham Nagaraj, Pratham R Bysani, Sripurna Dutta, SA Nagesh, Bevinahalli N Nandeesh, Balaji Sanjeev Pai
DOI:10.4103/jcrsm.jcrsm_7_18  
Epidermoids are extra-axial brain lesions seen mostly in the cerebellopontine angle with typical imaging characteristics. We present a case of the right frontal intraparenchymal epidermoid cyst with atypical magnetic resonance imaging features. This case report is to highlight the rarity of location and atypical radiological feature.
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LETTER TO EDITOR Top

Imaging features of branchial cleft cyst p. 71
Reddy Ravikanth, Denver Steven Pinto, Regan Anthony Fernandes
DOI:10.4103/jcrsm.jcrsm_62_17  
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