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   2017| May-August  | Volume 10 | Issue 2  
    Online since May 30, 2017

 
 
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ORIGINAL ARTICLES
Correlation of serum ferritin levels, in female patients with chronic diffuse hair loss: A cross sectional study
Sridevi Ramachandra Raichur, AM Pandit, Anil Malleshappa
May-August 2017, 10(2):190-195
DOI:10.4103/kleuhsj.ijhs_312_16  
Context: Iron is involved in critical physiological processes within the hair follicle, suggesting that iron deficiency (ID) could disrupt hair synthesis. The relationship between body iron status and hair loss has been investigated in a number of studies, however, with relatively discrepant findings. Aim: The aim of this study is to evaluate whether chronic telogen effluvium (CTE) and female pattern hair loss (FPHL) in patients were associated with decreased tissue iron stores, as measured by serum ferritin levels. Setting and Design: This was a cross-sectional study, conducted in a teaching hospital. Materials and Methods: Forty female patients aged between 15 and 45 years, having chronic diffuse hair loss, were recruited. Statistical Analysis Used: Statistical analysis used in this study was Mean ± standard deviation, Pearson's correlation coefficient, and one-sample t-test. Results: The mean serum ferritin levels in all participants, CTE, and FPHL were 18.6 μg/L, 16 μg/L, and 36.64 μg/L, respectively. Almost 57.5% of participants had serum ferritin levels <12 μg/L indicating ID, and 15% of participants had serum ferritin levels ranging 13–20 μg/L indicating iron depletion. Twenty-five percent of participants had serum ferritin levels ranging from 21 to 70 μg/L, indicating that serum ferritin levels were lower than required for normal hair cycle. Since there is a wide range of serum ferritin level (6–160 μg/L), a cutoff level of 41 μg/L was used to observe ID. There was a significant difference between the mean serum ferritin levels of participants as compared to the cutoff level of serum ferritin. Mean serum ferritin levels of all participants and in participants with CTE were low. Many participants had serum ferritin levels less than the normal lower range. The participants showed ID, at cutoff level of serum ferritin (41 μg/L), which was significant. Conclusion: Participants of this study had low serum ferritin levels at different definitions of ID, and the participants showed ID, which was significant. Hence, chronic diffuse hair loss was associated with decreased iron stores.
  14,926 505 3
Assessment of static and dynamic balance in overweight and obese children with and without flatfoot: A cross-sectional study
Pallavi Sharma, Deepa Metgud
May-August 2017, 10(2):173-177
DOI:10.4103/kleuhsj.ijhs_71_16  
Background: Childhood obesity and overweight have been referred by health organization as serious epidemic and global problems that are on the rise. The consequence of being overweight in children is the greater impairment of mobility which may result in several orthopedic conditions. The foot dimensions of overweight children and obese children will be larger than those of normal weight children. Balance is defined as an ability to maintain the center of mass over base of support. Balance as a sensorimotor ability helps in maintaining static and dynamic equilibrium. The presence of abnormalities in the foot structures may affect the displacement of the body, function in static, and dynamic position. Methodology: This was a cross-sectional study done in overweight and obese children with and without flatfoot. A total of 1165 children were screened out of which 87 were found to have obesity between the age group of 6–12 years from 11 schools. Static balance of children was measured using balance error scoring system (BESS) and stork balance stand test (SBST), and dynamic balance was measured using four square step test (FSST) and modified bass test of dynamic balance (MBTDB). Results: The static balance was significantly affected in obese children with and without flatfoot and also in overweight children with flatfoot whereas dynamic balance was affected in obese children with flatfoot. BESS (P = 0.001), MBTDB (P = 0.006), and FSST (P = 0.001) were statistically significant. There was no significant difference found on SBST (P = 0.0657) when compared within and between the groups. Conclusion: Obese children with flatfoot had poor static and dynamic balance compared to overweight children with flatfoot when it was tested on BESS and MBTDB and FSST.
  3,997 457 2
Comparative evaluation of postoperative pain after single visit endodontic treatment using ProTaper Universal and ProTaper Next rotary file systems: A randomized clinical trial
Neha Arora, Sonal Bakul Joshi
May-August 2017, 10(2):124-130
DOI:10.4103/kleuhsj.ijhs_427_16  
Introduction: Root canal preparation may cause inadvertent apical extrusion of debris causing postoperative pain. This debris varies with the instrumentation technique and design characteristics. One of the major revolutions in the design of the instruments is the introduction of files with an offset center of mass or/and rotation, which causes asymmetric rotary motion in the canal. An example is the ProTaper Next (PTN) rotary file system. In vitro studies have shown that this system extrudes lesser debris than more commonly used ProTaper Universal (PTU). However, in clinical circumstances, periapical tissues may act as a natural barrier and host immune response may affect the response. Hence, the aim of the present study was to evaluate and compare the postoperative pain after single visit endodontic treatment using PTU and PTN rotary file systems. Study Design: A total of 80 patients were assigned to two groups according to the root canal instrumentation technique used, PTU or PTN. Root canal treatment was carried out in a single appointment, and the severity of postoperative pain was assessed using visual analog scale score after 6, 24, 48, and 72 h. The association of variables (age and sex) and root canal preparation time were also evaluated and compared between the groups. Results: Postoperative pain was significantly higher in PTU group than PTN group. The highest pain was observed at 6 h interval which reduced with each time with no pain at 72 h interval in both the groups. Significantly, more amount of time was involved with PTU as compared to PTN. A significantly higher pain was observed with advancing age and in females. Conclusion: The postoperative pain was significantly higher in patients undergoing canal instrumentation with PTU rotary instruments as compared to the PTN rotary instruments.
  3,588 432 1
Utilization of janani suraksha yojana by eligible pregnant women in rural South India: A qualitative study
Biswamitra Sahu, Anita Nath, R Anil Kumar
May-August 2017, 10(2):104-109
DOI:10.4103/kleuhsj.ijhs_5_17  
Context: In India, the Janani Suraksha Yojana (JSY) scheme, translated as “safe motherhood scheme,” has been implemented to tackle this financial insecurity by giving cash incentives to women who give birth in public health facilities and accredited private health facilities. Although there is a reported increase in the number of institutional deliveries, there has not been much improvement in maternal or neonatal mortality rates. Objective: To explore the utilization of and barriers toward the use of JSY scheme by eligible rural pregnant women. Design: Qualitative research method in the form of in-depth interview was used for data collection and analysis. Methodology: The study was conducted in seven villages of Bellary district in Karnataka, South India. In depth interview was conducted for the study participants included twenty women who had delivered over the last 1 year and were selected by purposive sampling from antenatal registers which were available from the primary and community health centers in the district. Results: About 80% had delivered at public sector health facilities. To pay for the financial deficit to meet the pregnancy-related expenses, a large number of participants expressed to have raised money from loans, mortgage of land and house, and selling of jewelry and livestock. Many narrated their experiences with the poor quality of care at the public sector health centers. Several participants faced problems ranging from those related to opening a bank account to cumbersome procedures and logistical issues for money encashment. Conclusion: The incentive which is given under JSY does not seem adequate as, despite its availability, the family still needs to incur lofty medical expenditure. Furthermore, lack of quality care at public health facilities results in excessive out of pocket expenditure incurred at private health centers. The encashment procedure is also fraught with cumbersome procedures once again leads to loss of work time and additional economic losses.
  3,589 282 1
Correlation of computed tomography and nasal endoscopic findings in chronic rhinosinusitis: A hospital-based study
Dharmistha Rajesh Kaku, Anilkumar Suryadev Harugop
May-August 2017, 10(2):116-123
DOI:10.4103/kleuhsj.ijhs_305_16  
Background: Computed tomography (CT) scan is a diagnostic tool for chronic rhinosinusitis (CRS). This study was attempted to correlate preoperative CT scan and endoscopic findings in patients with CRS. Aims: This study aimed to correlate CT scan and nasal endoscopic findings in the assessment of patients with CRS. Study Design: This is a hospital-based study. Subjects and Methods: One-year observational study was conducted in the Department of Otorhinolaryngology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. Thirty patients meeting 2007 revised criteria for CRS underwent CT scan of paranasal sinus, diagnostic nasal endoscopy, and functional endoscopic sinus surgery. Statistical Analysis: Statistical analysis was performed by Kappa's measure of agreement and P value. Results: Correlation between CT scan and endoscopy was good in cases of anterior ethmoids (right, k = 0.867; P< 0.02, left, k = 0.525, P = 0.003), concha bullosa (right, k = 0.68; P< 0.001, left, k = 0.520; P = 0.003), and maxillary sinus (right, k = 0.786; P< 0.001, left, k = 0.636; P< 0.001). Correlation was acceptable for frontal sinus (right, k = 0.488; P = 0.007, left, k = 0.493; P< 0.05), mucosal thickening (k = 0.525; P = 0.003), polypoidal changes (k = 0.457; P = 0.012), posterior ethmoids (right, k = 0.590; P = 0.04; left, k = 0.432, P = 0.015), and sphenoid sinus (right, k = 0.492; P = 0.006, left, k = 0.444; P = 0.013). Correlation was poor in cases of paradoxical middle turbinate (k = 0.384; P = 0.051) and osteomeatal complex (OMC) occlusion (right, k = 0.416; P = 0.011, left, k = 0.367; P = 0.020). Conclusions: Endoscopy was superior to CT scan in localizing pathologies such as polyp, edema, and discharge, whereas CT scan was useful for OMC assessment to visualize paranasal sinus and anatomical variations.
  3,320 319 -
“Evaluation of wound healing and bone regeneration using autologous platelet-rich plasma and platelet-rich fibrin postextractions”: A comparative study
Niyati Satish Balse, Shridhar Baliga
May-August 2017, 10(2):167-172
DOI:10.4103/kleuhsj.ijhs_395_16  
Introduction: It has already been established in the past that platelets play a major role in wound healing. Platelet- rich plasma (PRP) and Platelet- rich fibrin (PRF) are autologous concentrates of platelets in a relatively small volume of plasma and they enable delivery of growth factors in increased amounts to surgical sites to promote wound healing. Aims and Objectives: This study focuses on comparing the two platelet concentrates – platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) as graft materials in extraction sockets and their efficacy in wound healing and bone regeneration. Materials and Methods: Sixty patients requiring extraction of unilateral third molars were considered. Computer-generated random allocation of subjects was done.
  • Group A: PRP was used as the graft material in the third molar extraction socket
  • Group B: PRF was used as the graft material in the third molar extraction socket
  • Group C: No material was used as graft in the third molar extraction socket.
Soft tissue healing and bone healing were assessed in the postoperative follow up visits. Results: We observed that Group B showed significantly improved soft tissue healing and a faster bone healing as compared to Group A. Both Group A and Group B showed significantly better healing in terms of soft tissue and bone as compared to Group C. Conclusion: PRF shows better results in terms of soft tissue and bone healing as compared to PRP. The method of procuring PRF is easy as compared to that of procuring PRP.
  2,794 305 2
Risk of depression in patients with chronic obstructive pulmonary disease and its determinants
Sujeer Khan, Bhagyashri B Patil
May-August 2017, 10(2):110-115
DOI:10.4103/kleuhsj.ijhs_453_16  
Background and Objectives: Depression is an important comorbid condition of chronic obstructive pulmonary disease (COPD). There is a risk of undertreatment for depression in patients with COPD as depressive symptoms, including suicidal tendencies, can erroneously be conceptualized as an understandable reaction to COPD and not as signs of an independent depressive disorder. The exact prevalence of depression in COPD patients among the Indian population is unknown. Aim: This study aims to know the prevalence of depression in COPD patients attending tertiary care hospital. Materials and Methods: A total of 120 COPD patients were enrolled in the study according to Global initiative for COPD (GOLD) criteria 2015. They were screened for depression as per Beck's depression score. Results: Eighteen patients in stage 1, 66 patients in stage 2, 29 patients in stage 3, and 7 patients in stage 4 of the COPD were enrolled. The prevalence of depression in the study population was 55%. Conclusion: The prevalence of depression in COPD is very high. The factors associated with depression in COPD patients were the duration of the disease, body mass index, GOLD stage, and smoking. Duration of the disease and smoking was the most significant factors associated with depression in COPD. Patients with COPD should be screened for depression and those with higher depression score should undergo further evaluation. Further studies involving larger number of subjects from several centers are required to study the prevalence of depression in Indian patients with COPD.
  2,797 237 4
Comparison and assessment of the oral hygiene status and user satisfaction of a novel toothbrush and a regular commercial toothbrush: A questionnaire study
Rishi Ashok Bhimani, Shaila Veerappa Kothiwale
May-August 2017, 10(2):160-166
DOI:10.4103/kleuhsj.ijhs_397_16  
Background: Periodontal disease is the most prevalent diseases of the oral cavity. Etiology of periodontal diseases has been related to the dental plaque biofilm. Therefore, regular removal of dental plaque and prevention of its formation is essential to maintain optimum oral health. Plaque control measures have been broadly classified into - mechanical and chemical plaque control. Mechanical plaque control is a simple and effective tool for oral prophylaxis. Particularly, the daily use of a manual toothbrush with a toothpaste prevents oral diseases. A variety of toothbrush designs and configurations have been manufactured and evaluated for their efficacy Aims: To design an ergonomic novel toothbrush and compare its efficacy of oral hygiene with a standard commercial toothbrush and to assess and compare the satisfaction and comfort of the toothbrushes among the study subjects, through a self-constructed questionnaire. Settings and Design: Questionnaire study. Materials and Methods: A total of 60 subjects, 18-25 years of age who reported to the Department of Periodontics, KLE's V.K Institute of Dental Sciences were selected, as per inclusion and exclusion criteria for the study. The toothbrushes were provided and were asked to use each toothbrush for 15 days. At the end of the study, subjects were asked to fill a self-constructed questionnaire consisting of 8 closed-ended questions pertaining to the comfort, grip, head design, bristle design, accessibility and cleaning efficiency of the toothbrushes. Statistical Analysis: Chi-square test. Results: Questionnaire revealed 92% favoured for neck design and flexibility, 77.18% better accessibility to posterior teeth, 70.18% bristle design, 75.44% improved removal lodged food and 71.93% preferred TB2 over TB1 for overall comfort and brushing experience. Conclusion: The responses of the questionnaire revealed better satisfaction, comfort and oral hygiene with novel toothbrush compared to the standard commercial toothbrush.
  2,697 206 -
Effect of denture adhesive and its forms on microbial colonization in diabetic and nondiabetic complete denture wearers: An in vivo study
Ruta Jadhav, Sounyala Rayannavar, Raghunath Patil, Vinuta Hiremath, Sumati A Hogade
May-August 2017, 10(2):131-137
DOI:10.4103/kleuhsj.ijhs_436_16  
Problem: Denture adhesives are known to enhance the retention and stability in denture wearers, especially in patients with resorbed ridges. However, dentists hesitate to prescribe them fearing denture adhesive-induced oral microbial infections or hyperplasia in the oral cavity. Aim: The aim of this was to evaluate and compare the effect of denture adhesives and its forms on the microbial colonization of diabetic and nondiabetic edentulous patients using complete dentures. Methodology: Forty subjects were included in the study (Group A: 20 diabetics and Group B: 20 nondiabetics). After 2 weeks of complete denture insertion, samples were collected from the hard palate and buccal shelf areas for baseline microbiological analysis. Colony forming unit (CFU) counts were calculated on blood agar after 48 h of incubation. Ten subjects per group were prescribed with denture adhesive powder form and other 10 subjects with paste form, which was used for 1 month. After 1 month, subjects were recalled and CFU were evaluated. Results: The difference obtained between the CFU counts for T0 and T1 of both the groups; Group A and Group B showed no significant difference. As shown by the dependent t-test, there was a slight increase in the CFU counts of palatal area as compared to the buccal shelf area and increased counts for the paste form of denture adhesive as compared to the powder form of denture adhesive. However, these differences were statistically insignificant (P > 0.05). Conclusions: Microbial colonization of diabetic patients was far more than the nondiabetic patients. Denture adhesives had no effect on the microbial colonization when used for 1 month for both the groups. Furthermore, the microbial colonies were found to be slightly increased for hard palate and for the paste form of denture adhesive, however, statistically not significant.
  2,640 231 -
The visual outcome after cataract surgery with multifocal intraocular lenses and monofocal intraocular lenses at tertiary care hospital: A prospective observational study
Anjal M Shah, Umesh U Harakuni
May-August 2017, 10(2):145-154
DOI:10.4103/kleuhsj.ijhs_451_16  
Background: The crystalline lens is part of the optical system of the eye that focuses rays of light on the retina. Apart from contributing to the optical power of the eye as a whole, the crystalline lens can dynamically change the optical power of the system by the process of accommodation for younger eyes. During life the ability of the crystalline lens to change in shape decreases, leading to presbyopia. For optimal visual performance, crystalline lens should be transparent. Cataract describes the pathological opacification of the crystalline lens. Removal of the crystalline lens followed by implantation of an artificial intraocular lens (IOL) in the capsular bag of the eye, as practiced in cataract surgery, offers an opportunity to address refractive anomalies in patients who are ametropic due to the removal of cataract. Implantation of an IOL with a fixed focal point (monofocal IOL) will render a patient at best emmetropic for a single fixed working distance only, leading to a postoperative result comparable to presbyopia in an emmetropic subject; pseudoaccommodation can play a role in increasing the depth of field but spectacle independence for a range of working distances is not be expected after implantation of a monofocal IOL. To restore the missing accommodation, we can implant multifocal IOLs. Multifocal IOLs, on the other hand, are designed to have two or more fixed focal points, thus, facilitating a sharp retinal image of objects at multiple working distances resulting in increased spectacle independence, but these lenses can cause a reduction in contrast sensitivity and higher incidence of photic phenomena such as halos, flare, and glare. Aim of The Study: The study was carried out with the aim of comparing the visual outcome after cataract surgery with multifocal IOLs and monofocal IOLs in respect to distant visual acuity, near visual acuity, contrast sensitivity, subjective symptoms, and to assess functional status and quality of life. Materials and Methods: A prospective observational study was conducted in the Department of Ophthalmology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi on patients undergoing cataract surgery during January 1, 2015–December 31, 2015. The study was approved by the Ethical and Research Committee of Jawaharlal Nehru Medical College, Belagavi. Forty eyes of forty patients who undergone phacoemulsification surgery with IOL implantation under LA. Choice of IOL inserted given according to their desire for spectacle independency. Monofocal group was taken as control. Both groups were evaluated postoperatively after 3 weeks and 6 weeks for distant vision, near vision, contrast sensitivity for distance, subjective satisfaction by standard questionnaire method and subjective symptoms such as glare and halos and difficulty in night driving. Data were analyzed by Chi-square test (P < 0.05%). Results: Distant visual acuity was 6/6–6/9 in 80% and 75% of the patients of multifocal and monofocal groups, respectively, remaining patients had 6/12–6/18 vision. 85% of multifocal group had N6–N8 vision (P < 0.0001). High contrast sensitivity for distance was almost similar in both groups, but low contrast was significantly reduced in multifocal group as compared to monofocal group (P = 0.0023). Fifteen percent of multifocal group had complained of glare and halos compared to monofocal group who never had these visual sensations. About 5% of patients in multifocal group had difficulty with nighttime driving. Nearly, 80% of patients in multifocal group and 40% of patients in monofocal group had become spectacles independent. Interpretation and Conclusion: Multifocal IOL group experienced reduced spectacle dependency for near vision and a high level of patient satisfaction despite some reports of halos, glare, and difficulty in night driving. Monofocal IOL group experienced spectacle dependency for near vision. Overall, multifocal IOLs offer best near vision acuity, good distance visual acuity, less limitation in visual function in selected and motivated individuals.
  2,398 213 -
A comparative evaluation of different compensating curves and power arm length during retraction of maxillary anterior teeth: A finite element study
Dhvani Sumatichandra Doshi, Tejashri Mirji Pradhan
May-August 2017, 10(2):183-189
DOI:10.4103/kleuhsj.ijhs_392_16  
Introduction: The strategic design of an appliance for anterior retraction by using orthodontic mini-implant anchorage and sliding mechanics must take into account the height of the power arm and compensating curve in archwire. This study was conducted to analyze the change in maxillary anterior teeth displacement and stress distribution using different compensating curves in the arch wire and varying power arm length in first premolar extraction case during sliding mechanics. Materials and Methods: 6 geometric models were created using ANSYS software. This geometric model was converted into a finite element model with the help of software HYPERMESH 11.0. Bilaterally mini-implants were placed in the bone between the roots of maxillary second premolar and first molar. Power arms were placed at two heights – 3 mm and 5.5mm. Compensatory curves were placed in the archwire (0, 3mm or 5mm) and a force of 150 gms was applied using NiTi coil springs bilaterally. Stresses in bone and tooth displacements were analyzed. Results: There was more bodily movement of the teeth using the longer power arms. Incorporating a compensatory curve further helped to reduce tipping. The tooth that showed most bodily movement was the lateral incisor followed by central incisor and least by the canine. There was increased intrusion of the incisors and extrusion of canine with increase in power arm height. Conclusion: Increase in power arm height causes an increased intrusive tendency and increased bodily movement during en masse retraction of anterior teeth using mini- implant anchorage. Incorporation of a 5mm compensatory curve further helps reduce the tipping tendency of the anterior teeth.
  2,329 209 -
Characteristics and anesthetic management of patients presenting for cleft surgery
Babatunde B Osinaike, Stella A Ogunmuyiwa, Olalere O Gbolahan, AA Odewabi
May-August 2017, 10(2):216-220
DOI:10.4103/kleuhsj.ijhs_504_16  
Background: Anesthetic management during surgery for cleft repair can be challenging due to abnormal airway anatomy and preoperative medical conditions. We sought to determine the characteristics, type, and incidence of associated medical problems, airway and other intraoperative complications in patients who presented to our facility for cleft lip and palate repair. Methodology: Fifty-six consecutive patients aged 16 years and below who had surgical repair of cleft lip or palate under general anesthesia during the study period were involved in this prospective, observational study. Routine preoperative review and anesthetic management were not altered. Preoperative medical and airway problems, associated congenital anomalies, intubation outcomes, intraoperative anesthetic complications, and postoperative airway problems were recorded by a blinded observer. Results: Forty-eight (72.7%) and 18 (27.3%) of the 56 patients had cleft lip and palate repair, respectively. Baseline packed cell volume was not significantly different. The incidence of upper respiratory tract infections (URTIs) and anemia were 33% and 0%, respectively, in the cleft palate repair group compared to 18.8% and 16.7% in the cleft lip repair group. Difficult laryngoscopy was found in 4.2% and 11.1% of patients that presented for cleft lip and palate repairs, respectively, and the overall incidence of desaturation was 7.5%. The mean blood loss was more in the cleft palate group compared to that of the cleft lip repair group (33.33 ± 37.73 versus 7.92 ± 6.51, P = 0.001). Conclusions: Cleft lip repair was most common in our review, and URTI was the predominant comorbidity in both groups. The risk of a wide range of perioperative airway complications necessitates the presence of skilled manpower during general anesthesia for cleft lip and palate surgery.
  2,306 186 1
A cross-sectional study of p53 expression in patients with squamous cell carcinoma cervix: A hospital-based study
Niharika Singh, Hema Bannur
May-August 2017, 10(2):203-207
DOI:10.4103/kleuhsj.ijhs_495_16  
Context: Cervical cancer is the second most common cancer in women in India and the fourth most common cancer in women worldwide. The p53 is a tumor suppressor gene. Overexpression of p53 is detected by immunohistochemistry (IHC) and it indicates a worsened prognosis in some malignancies. Aims: The present study was undertaken to assess the expression of p53 by IHC in normal cervical epithelium and squamous cell carcinoma (SCC) cervix. The role of p53 as a potential biomarker by correlating p53 expression with clinico-pathological parameters was also studied. Settings and Design: Cross-sectional study. Subjects and Methods: A total of 50 cases of cervical biopsy or hysterectomy specimens of SCC cervix and fifty cases of hysterectomy specimens for other gynecologic causes were included in the study. IHC was used to study the p53 expression in normal and neoplastic cervical epithelium. The p53 positivity was assessed by using a semi quantitative method in SCC cervix. The p53 expression was correlated with various clinico-pathological parameters. Statistical Analysis Used: Data collected was analyzed using appropriate statistical test. Results: All the fifty cases (100%) of SCC cervix showed positive p53 expression. The normal cervical epithelium in 90% cases was p53 negative and 10% showed basal layer positivity. A statistically significant correlation was seen between p53 score and menopausal status (P = 0.010). Conclusions: Overexpression of p53 is suggestive of high grade of tumor.
  2,257 181 1
CASE REPORT
Development of mucinous adenocarcinoma in chronic fistula-in-ano: A case study
Pradeep S Shindhe, Ramesh S Killedar, Raju Y Timmapur
May-August 2017, 10(2):225-227
DOI:10.4103/kleuhsj.ijhs_277_16  
Chronic perianal fistulas are a common clinical condition. However, their evolution to carcinoma is rare. We report a case of recurrent chronic perineal fistula which turned into malignant tumor. The diagnosis was established by clinical examination, repeated biopsy, and colonoscopy. Clinical examination features suggested malignancy, but initial biopsy report showed cellular atypia and colonoscopy followed with biopsy revealed as large ulcerated rectal growth suggesting Carcinoma (CA) rectum and histopathological report showed infiltrating mucinous adenocarcinoma. It is suggested that this rare complication of chronic fistula-in-ano may be prevented by prompt expert management of complex primary fistula.
  2,256 145 -
GUEST EDITORIAL
Publication explosion and ethics: A cause of concern
Subarna Roy
May-August 2017, 10(2):101-103
DOI:10.4103/2349-5006.207270  
  2,068 212 -
ORIGINAL ARTICLES
“Comparative evaluation of intranasal dexmedetomidine and intranasal midazolam for premedication in children undergoing anesthesia”: A 1-year double-blind randomized controlled trial
Narendra Malineni, Manjunath C Patil
May-August 2017, 10(2):155-159
DOI:10.4103/2349-5006.207264  
Introduction: Children undergoing surgical procedures can experience significant anxiety and distress during perioperative period. Use of sedative premedication helps to reduce anxiety and facilitate a smooth induction of anesthesia. Midazolam is the most commonly used premedication agent with adverse effects such as behavioral changes, hiccups, and paradoxical hyperactive reactions. Dexmedetomidine, a highly selective α-2 agonist, has sedative properties. Aims and Objectives: The aim and objective of this study was to compare the efficacy of intranasal dexmedetomidine and intranasal midazolam for premedication in pediatric age group for parental separation anxiety and acceptance of anesthesia mask. Materials and Methods: This study included 60 American Society of Anesthesiologists I–II patients aged 1–10 years undergoing lower abdominal and lower limb surgeries under caudal epidural anesthesia. Ethical committee's clearance and informed consent were obtained. Patients were allocated into two groups by a computer-generated randomization table to receive 0.2 mg/kg intranasal midazolam in Group M and 1 μg/kg dexmedetomidine in Group D intranasally using 1 ml tuberculin syringe. The Parental Separation Anxiety Scale (PSAS) and Mask Acceptance Scale (MAS) were assessed by an anesthesiologist blinded to the drug given. Heart rate and oxygen saturation were monitored till the end of the procedure. Results: Demographic data were comparable in both groups (P > 0.05). Mean PSAS was 1.2 ± 0.40 in dexmedetomidine group and 1.6 ± 0.56 in midazolam group (P = 0.003). Mean mask acceptance score (MAS) at the time of induction was 1.7 ± 0.59 in dexmedetomidine group and 2.1 ± 0.58 in midazolam group (P = 0.02). Conclusion: Intranasal dexmedetomidine 1 μg/kg is an effective alternative for premedication in children undergoing anesthesia and it results in better parent separation and better mask acceptance at the time of induction when compared to intranasal midazolam 0.2 mg/kg without much side effects or complications.
  2,109 166 -
Comparative evaluation of the effect of commercially available two different forms of denture cleansers on denture biofilm in diabetic and nondiabetic individuals: An in vivo study
Heena Sharma, Raghunath Patil, Jyoti M Nagmoti
May-August 2017, 10(2):196-202
DOI:10.4103/kleuhsj.ijhs_434_16  
Statement of Problem: Denture cleansers are known to decrease the microbial counts in denture wearers. In certain medical conditions such as in diabetes, achieving reduction in microbial count and maintaining proper denture hygiene is difficult. Denture cleansers are used as an aid in maintaining denture hygiene in such patients. A number of tablets, pastes, and powders are available for cleaning dentures. Although the comparison of chemical methods and brushing is relatively common, their difference in diabetic denture biofilm and nondiabetic denture biofilm has not been previously described. Purpose: The purpose of this study was to investigate the effect of commercially available two different forms of denture cleansers on the denture biofilm in diabetic and nondiabetic denture-wearing individuals. Methodology: Twenty diabetic denture and 20 nondiabetic denture wearers were randomly selected for the study. Denture biofilm was collected twice for each participant, before and after use of denture cleanser for 21-day period. For sample collection, complete dentures were rinsed with distilled water and brushed. Inoculation was done with sterile loop and cultured on blood agar and chrome agar. Blood agar plates were incubated at 370°C for 24 h and chrome agar at 290°C for 24 h. Colonies' characteristics of the Streptococcus species and Candida species were counted after the incubation period. Results: The results showed a statistically significant reduction in the colony-forming unit (CFU) counts after the usage of denture cleansers. Furthermore, the Candidal count difference obtained by the use of effervescent tablets was more than paste form. Conclusions: The present study concluded that microbial colonization count of diabetic and nondiabetic denture biofilm significantly reduced after 21 days of usage of denture cleansers, and the effervescent tablets were more effective against Candida than paste form.
  2,112 143 -
Bibliometric evaluation of published Indian research on “Knowledge, Attitude, and Practices”
Sandeep Sachdeva, TR Sachdev, Ruchi Sachdeva
May-August 2017, 10(2):208-215
DOI:10.4103/kleuhsj.ijhs_4_17  
Objective: Evaluation of knowledge, attitude, and practices (KAPs) based published Indian research on selected parameters. Methodology: A bibliometric analysis of Indian KAP research manuscript published in journals indexed in PubMed for the last 2 years and/or published in Indian Journal of Community Medicine (IJCM) and Indian Journal of Public Health (IJPH) for the last 15 years (year 2000–2014) was undertaken under certain criteria. Results: PubMed (n = 196) revealed maximum KAP research undertaken from the states of Karnataka (16.8%) followed by Delhi (9.6%), Maharashtra (9.1%), and more than two states (11.7%). There was poor reflection with no publication of KAP-based research from the states of Chhattisgarh, Himachal Pradesh, Jammu and Kashmir, and Rajasthan, in IJCM and IJPH journals. The geographical representation of country through published manuscript in IJCM was slightly more diverse than IJPH and more than one-fourth manuscripts in IJPH were published from West Bengal only. It was evident that IJCM (n = 71) has published more KAP manuscripts than IJPH (n = 47). Higher proportion of community-based KAP research was published in IJPH (80.8%) than IJCM (57.7%). Highest single research domain in PubMed indexed journals was those related to oral cavity (14.2%) conducted by dental professionals while rest (85.8%) could be largely ascribed to community physician/public health personnel, etc. The first research domain was followed by family planning/contraceptives (6.1%), tobacco control (5.6%), and AIDS-HIV (5.1%), for the year 2013–2014. Highest KAP-based research domain of articles published in IJCM was those related to family planning/contraceptives (10.0%) followed by AIDS-HIV (8.5%) while it was tobacco (16.6%) and AIDS-HIV (14.5%) in IJPH. Number of authors/manuscript was slightly higher in journals indexed in PubMed (4.7) than IJCM (3.8) and IJPH (3.7). The average page/manuscript was higher in PubMed (6.4) indexed journals while it was similar in both Indian journal (IJCM [3.6] and IJPH [3.8]). Approximate time incurred in decision announcement toward acceptance of KAP manuscript (2000–2014) by IJCM from the date of submission was 7 months (median) while for comparison purpose, it was 6 months (median) for a sample of articles published during 2015.Average citations per KAP document within 2 years of publication were 1.9 (IJCM) and 1.2 (IJPH), respectively, in Google scholar. Conclusion: This bibliometric study, probably first of its kind in India, provides objective snap-shot of diverse published research in the country that may also aid scholar to explore new avenues of KAP especially non-communicable diseases in future. In-addition, postgraduate training could lay emphasis on the use of bibliometrics.
  2,074 149 1
A study of clinical profile in different serological diagnostic parameters of dengue fever
Rohit Morlawar, VA Kothiwale
May-August 2017, 10(2):178-182
DOI:10.4103/kleuhsj.ijhs_73_16  
Background and Objectives: Dengue fever a mosquito borne viral infection poses an serious situation due to lack of antiviral drugs or vaccine.[1] Worldwide, an estimated 2.5 billion people are at risk of infection.[2] It is estimated that more than 50 million infections occur each year, of which 500,000 hospitalizations are of dengue haemorrhagic fever with the case fatality rate exceeding 5% in some areas. The objective of this research was to study the clinical profile in different serological diagnostic parameters of dengue fever. Methodology: The present study was conducted in Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum In patients with dengue fever from January 2014 to December 2014.The study design was one year cross-sectional study. A total of 180 dengue fever patients were studied. Results:
  • Out of 180 patients 72.22% of the patients were males and male to female ratio was 2.6: 1
  • In the study all the patients presented with fever (100%).
  • In this study 127 (70.56%) patients presented with melaena, the p value was 0.025
  • In the present study 113 (62.78%) patients presented with rash. p = 0.045.
  • Platelet count of 20000 to 49999/cumm was in 51 patients (28.33%) with a p = 0.010.
  • In this study serum creatinine levels were raised in 15% of the patients and the value was p = 0.029
Conclusion and Interpretation: The findings of this study highlight that clinical profile of dengue fever based on clinical features viz. rash, and laboratory parameters that is, platelet count, serum creatinine which showed significant variations in different dengue serological tests.
  2,039 180 1
Primary ureterocalicostomy in children
Rajendra B Nerli, Prasad V Magdum, Amey Pathade, Reddy N Mallikarjun, Nitin D Pingale, Shridhar C Ghagane, Murigendra B Hiremath
May-August 2017, 10(2):221-224
DOI:10.4103/kleuhsj.ijhs_301_16  
Introduction: Ureterocalicostomy involves excision of the hydronephrotic lower renal pole parenchyma and anastomosis of the dismembered ureter directly to the lower pole calyx. Ureterocalicostomy offers distinct advantages over conventional Anderson–Hynes pyeloplasty for the primary surgical management of pelvi-ureteric junction obstruction, notably for obstruction secondary to complicating anatomical anomalies of the kidney, such as horseshoe kidney. The present study was aimed to evaluate the outcome of primary laparoscopic ureterocalicostomy as a primary procedure in children. Materials and Methods: The technique of ureterocalicostomy employed was similar in all children and comprised disconnection of the ureter from the renal pelvis and identification of the most dependent portion of the lower pole calyx by instrumentation within the collecting system. Results: Eight children (five males and three females) underwent primary ureterocalicostomy during the study period. The mean age of the children was 11.37 ± 3.67 years. Five of the eight children underwent laparoscopic ureterocalicostomy, whereas in three, it was necessary to convert to open as the dissection was difficult. The mean operating time was 134 ± 12 min, and the mean blood loss was 48 ± 7.48 cc. Conclusions: Our study shows that primary laparoscopic ureterocalicostomy for ureteropelvic junction obstruction is feasible, safe, and associated with minimal morbidity.
  1,879 133 -
Determination of minimum instrumentation size for penetration of diode laser against Enterococcus faecalis in root canals using scanning electron microscope: An in vitro study
Niraj Jayant Godbole, Preeti K Dodwad, Kishore Bhat, Anand Patil
May-August 2017, 10(2):138-144
DOI:10.4103/kleuhsj.ijhs_429_16  
Aim: The aim of this study was to determine minimum instrumentation size for penetration of diode laser against Enterococcus faecalis in root canals using scanning electron microscope (SEM). Methodology: Fifty-five single-rooted human permanent maxillary anterior teeth were selected. The sterilized specimens were inoculated with 5 μl E. faecalis culture grown in diluted brain–heart infusion broth and incubated at 37°C for 4 weeks. After 4 weeks, 5 samples were selected as baseline group to evaluate the depth of penetration of E. faecalis. Remaining 50 samples were divided into 5 groups based on the apical enlargement size using ProTaper file system: Group 1 – canal preparation done till #F1 size file; Group 2 – canal preparation done till #F2 size file; Group 3– canal preparation done till #F3 size file; Group 4 – canal preparation done till #F4 size file; Group 5 – canal preparation done till #F5 size file. The canals were prepared and then irradiated with 940 nm diode laser at a power setting of 1.5W for 5 s. The procedure was repeated 4 times with intervals of 10 s between each one. All the samples were then transversely sectioned at 2 mm and 5 mm from the apex. Each section was then examined under a SEM to evaluate the depth of penetration of E. faecalis in the baseline group and depth of penetration of diode laser in the experimental groups. The results were analyzed using the two-way ANOVA and Tukey's multiple post hoc test. Results: Depth of penetration of laser was highest in Group 3 in apical third region and was statistically significant when compared to Group 1 and Group 2 in the middle and apical third regions. However, no statistically significant difference was noted between Group 3, Group 4, and Group 5. Conclusion: It can be concluded that the apical instrumentation to a size F3 using ProTaper file system along with irradiation using a diode laser showed a greater depth of penetration into dentin and thus reducing residual microorganisms. Furthermore, conserving as much tooth structure as possible, thereby increasing the predictability of success.
  1,840 161 -