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   2020| April-June  | Volume 10 | Issue 2  
    Online since April 3, 2020

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Chloroquine: Can it be a Novel Drug for COVID-19
Dinesh Kumar Badyal, Rajiv Mahajan
April-June 2020, 10(2):128-130
Coronavirus disease 2019 (COVID-19) has been declared a pandemic by the World Health Organization. The United States Food and Drug Administration has not approved any drug or vaccine for the treatment of COVID-19; however, reports have emerged from different parts of the world about the potential therapeutic benefits of existing drugs. Chloroquine and phosphate hydroxychloroquine are the drugs currently in the limelight, and recently, the National Task Force for COVID-19 constituted by the Indian Council of Medical Research has recommended the use of antimalarial drug hydroxychloroquine for prophylaxis of severe acute respiratory syndrome-coronavirus 2 infection in selected high-risk individuals. This short write-up explores the potential efficacy and established safety of chloroquine in COVID-19.
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Internal assessment in new MBBS curriculum: Methods and logistics
Dinesh Kumar Badyal, Monika Sharma
April-June 2020, 10(2):68-75
Assessment is a pivotal element of competency-based curriculum. The implementation of competency-based undergraduate medical curriculum in India requires proper implementation of updates in assessment for which universities, colleges, and teachers need to plan and design internal assessment (IA) modules as well as guidelines. IA provides opportunity to assess many competencies and hence should be implemented judiciously. Multiple assessment methods should be used to improve utility of IA. The process should involve all the teachers of a subject and all competencies. Capacity building trainings should be organized by institutes in basic concepts of assessment as well as training in methods such as the objective structured clinical/practical examination, direct observation of procedural skills, and mini-clinical evaluation exercises. The culture of providing regular feedback needs to be instilled at institute levels. The learners who are not able to achieve competencies and required criteria in university examination should be provided predecided remedial measures for improving their performance. The article discusses all these aspects in detail.
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Giant dental calculus: A rare case report and review
Yashodeep Chauhan, Sandhya Jain, Madhu Singh Ratre, Shaleen Khetarpal, Manish Varma
April-June 2020, 10(2):134-136
Inadequate oral hygiene is the root cause of the initiation and establishment of the periodontal disease. Dental calculus serves as plaque retentive area, thereby contributing to gingivitis and periodontitis. The present unusual case is of a 55-year-old female patient reported to the department of periodontology with a chief complaint of hard deposit at the right maxillary and mandibular posterior region. The patient was found to have very heavy calculus deposition with respect to right maxillary and mandibular posterior teeth, and the patient was using the left side for mastication and avoiding chewing from the right side mainly due to some periodontal problem. The extraction of the hopeless teeth along with dental calculus was done. Dimensions of dental calculi at maxillary and mandibular teeth was 4 cm × 3 cm each.
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Scanning electron microscope corroboration of ameloglyphics – A new tool in forensic odontology
Kanika Singroha, Abhishek Banerjee, VV Kamath, J Pramod, Saha Alangkar, E Elampovai
April-June 2020, 10(2):76-80
Background: Human teeth resist decomposition to the maximum and has immense potential to serve as hard-tissue counterpart to dermatoglyphics in forensic odontology. Ameloglyphics is the science of recording and analyzing the tooth print. Aims and Objectives: To assess the scope of viability, reproducibility, and identification of enamel prints (akin to fingerprints) and their patterns as a tool for identification. To establish that expression of enamel prints is a direct result of the enamel rod configuration on the surface of the crown as detected by scanning electron microscope (SEM). Materials and Methods: The teeth samples (n = 10) were first analyzed through (SEM) and the image of the arrangement of rods on the surface was captured. Enamel prints were registered in a standard procedure by virtue of ink transfer on a cellophane tape from etched tooth enamel surface of the same samples. These prints and SEM images were subjected to Rapid Sizer® image editing software to obtain a pattern (sketched outline image software). Patterns were identified manually. Results: Reproducibility, specificity, and feasibility of the above procedure were determined. There appeared to be a high rate of reproducibility (98%–100%) and specificity (100%). The paraphernalia required as well as the technique entrenched were feasible. Furthermore, the SEM analysis established the viability and reliability. Conclusion: Ameloglyphics is a sensitive and reproducible scientific tool that can be utilized for the management, examination, and evaluation of dental evidence for identification at crime scene and disaster sites. Its importance vis-a-vis fingerprints cannot be understated, especially in view of the seeming indestructibility of the enamel.
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Molecular detection of aspergillus in sputum of patients with lower respiratory tract infections
Alosha Sharma, Dakshina Bisht, Shukla Das, Gargi Rai, Shyama Dutt, VK Arora
April-June 2020, 10(2):86-90
Background: Raised incidences of respiratory tract infections due to fungal agents in immunocompetent individuals are a cause of concern due to the unavailability of rapid diagnostic methods. Materials and Methods: Sputum and serum samples were collected from patients having lower respiratory tract infections (LRTIs), serum samples were screened for the presence of anti Aspergillus antibodies and sputum samples were homogenized and processed for identification of Aspergillus by conventional methods and further subjected to polymerase chain reaction (PCR) using genus-specific ITS 4-5 primers. Results: PCR identified Aspergillu s in 28% sputum samples, which was high as compared to conventional methods. Conclusion: Simple conventional PCR technique proves to be useful screening in for early identification of Aspergillus colonization in patients with LRTI, which can prevent irreversible damage in their lungs by fungal invasion.
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Beliefs and intention to organ donation: A household survey
Ayman El-Menyar, Hassan Al-Thani, Tulika Mehta, Betsy Varughese, Yousuf Al-Maslamani, Ahammed Abdulla Mekkodathil, Rajvir Singh
April-June 2020, 10(2):122-127
Background: Organ transplantation is considered as the last therapeutic option for the treatment for end-stage organ failure. However, the gap between the demand and supply of transplantable organs is still wide. Extensive researches have been conducted to understand this gap, and many countries have introduced Opt-out laws and have started targeted awareness programs. We aimed to assess, among the household residents, the normative behavior and beliefs and its correlation to intentions toward becoming organ donors. Subjects and Methods: A household survey with the resident population of Qatar was conducted from October 2016 to November 2016. A sample of 1044 individuals aged 18 and above, residing in eight municipalities within the country, was selected using a two-stage systematic random sampling method to understand the relationship between organ donation intentions and behavioral, normative, and control beliefs. Independent female enumerators collected data on electronic tablets and exported to SPSS for data analysis. Results: Data from 930/1044 (89%) individuals responded to the intention-related questions were taken for final analysis. Multivariate analysis brought out that behavioral beliefs (standardized beta coefficient = 0.25, t = 6.5, P = 0.001) and normative beliefs (standardized beta coefficient = 0.32, t = 8.4, P = 0.001) were significant contributors to intention to donate organs whereas control beliefs (standardized beta coefficient = −0.07, t = −2.3, P = 0.02) were negatively associated to organ donation intention. Conclusions: Findings indicate that behavioral and normative beliefs play a very important role in contributing to the intention of the individual toward organ donation.
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Adherence to oral hypoglycemic drugs among type 2 diabetic patients in a resource-poor setting
Israel Abebrese Sefah, Archibald Okotah, Daniel Kwame Afriyie, Seth Kwabena Amponsah
April-June 2020, 10(2):102-109
Objective: Diabetes mellitus is a growing public health problem in many countries including Ghana. Adherence to drugs, especially among patients with type 2 diabetes mellitus (T2DM) is often poor is some resource-poor settings. The objective of this study was to assess adherence to oral hypoglycemic drugs and factors that affect adherence among patients with T2DM in the Volta Region of Ghana. Methods: The study was cross-sectional and conducted among 400 patients with T2DM attending diabetic clinics at 4 randomly selected hospitals in the Volta Region of Ghana between January 10 and March 30, 2015. Patients were interviewed using a structured questionnaire and other data collection tools to determine the commonest self-reported reason(s) for nonadherence. Adherence was assessed using the 8-item Morisky Medication Adherence Scale. Multivariate analysis was performed between adherence and statistically significant patient variables. Results: Adherence to oral hypoglycemic drugs among T2DM patients was 47.75%. The odds of adherence with fasting blood glucose between 1 and 6 mmol/L was approximately two-fold (adjusted odd ratio [aOR] =1.92, confidence interval [CI]: 1.11–3.32) versus the odds of having fasting blood glucose of above 10 mmol/L. The odds of adherence among patients with tertiary education was approximately three-fold (aOR = 3.01 CI: 1.44–6.269) versus patients with no formal education. The commonest self-reported reason for nonadherence was forgetfulness. Conclusion: Adherence to oral hypoglycemic drugs among T2DM patients in the current study was sub-optimal. Therefore, in such settings, management of T2DM must include strategies to identify nonadherent patients, and regular patient education and counseling.
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Mentorship program: Modern outlook of traditional knowledge
Sahiba Kukreja, Rohit Arora, Rajiv Mahajan, Tejinder Singh
April-June 2020, 10(2):65-67
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An unusual cause of mediastinal mass and chylothorax
Laxma Reddy Sattavarapu, Narendra Kumar Narahari, Deepika Shree Balaram, Anu Kapoor, GK Paramjyothi
April-June 2020, 10(2):143-146
Mediastinal masses are commonly encountered in clinical practice. The commonly encountered anterior mediastinal masses include those of thymic or thyroid origin, teratomas, and lymphoma. Establishing the diagnosis by histopathology is essential considering the wide range of differential diagnosis and to exclude malignancies. Here, we present an unusual case of large mediastinal mass with chylothorax in a young immunocompetent female.
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Cell proteins interacting with the human immunodeficiency virus in immunoblotting can be detected by R5- or X4- tropic human immunodeficiency virus particles
Zeina Soayfane, Bilal Houshaymi, Mamdouh H Kedees, Laurent Belec, Nadine Nasreddine
April-June 2020, 10(2):81-85
Introduction: The present study reported a new immunoblot assay, with revelation by R5- or X4-whole free human immunodeficiency virus (HIV) particles or recombinant gp160. Materials and Methods: The assay was optimized to identify cell proteins interacting with HIV. Whole cell lysates were prepared from peripheral blood lymphocytes (PBLs), dendritic cells (DC), monocyte-derived macrophage (MDM), and Henrietta Lacks (Hela, wild-type or transfected with DC-specific intracellular adhesion molecule-3-Grabbing Non-Integrin, HeLa) and Human endometrial cells (HEC-1A) lines; HIV particles used were the R5-tropic HIV-1JRCSFand the X4-tropic HIV-1NDK. Results: Experiments with PBL lysates and both viruses demonstrated different bands, including a unique band at 105–117 kDa in addition to nonspecific bands. The 105–117 kDa band migrated at the same level of that observed in controls using total PBL lysate and anti-CD4 mAb for detection and thus likely corresponds to the cluster difference (CD) 4 complex. Blots using lysates of DCs, MDM, HeLa cell line, and HEC-1A cell line allowed identifying several bands that positions were similar to that seen by recombinant gp160 or whole R5- or X4-HIV particles. Conclusion: Blot of whole lysates of various HIV target cells is recognized by free HIV particles and allows identifying a wide range of HIV-interacting cell proteins. Such optimized assay could be useful to recognize new cellular HIV attachment proteins.
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Comparison of estrogen and progesterone receptor status in tumor mass and axillary lymph node metastasis in patients with carcinoma breast
Shikha Singh, Samarth Shukla, Ashok Singh, Sourya Acharya, RP Kadu, Arvind Bhake
April-June 2020, 10(2):117-121
Introduction: Breast malignancy is a hormone-dependent tumor. The hormone receptor status in the primary tumor is required while taking decision for starting adjuvant therapy. The estrogen receptor (ER) and progesterone receptor (PR) status is also an important prognostic marker. Materials and Methods: All modified radical mastectomy cases with axillary lymph node dissection were taken. H and E staining was done. All lymph node-positive breast cancer cases were subjected to immunohistochemistry using ER and PR antibodies. Results: In the study of 60 cases, the level of concordance between the primary tumor and the metastatic lymph node was 98.33% for ER and 96.66% for PR. Conclusion: There exists a positive correlation between the hormone receptor status of the primary tumor and the paired axillary lymph nodes.
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Quantitative polymerase chain reaction analysis of cariogenic streptococcus mutans in saliva of oral and laryngeal cancer patients undergoing radiotherapy: A clinical study
Shilpi Rajiv Daveshwar, Sonali Vinod Kapoor, Meena Rajiv Daveshwar,
April-June 2020, 10(2):91-96
Context: Radiotherapy leads to radiation-induced caries. There is limited knowledge about the quantification of cariogenic bacteria in the saliva of irradiated cancer patients. Objective: The aim of this study is to check salivary pH, flow rate, and the assessment of Streptococcus mutans in the saliva of irradiated oral and laryngeal cancer patients using quantitative real-time polymerase chain reaction (qRT-PCR). Settings and Design: This was time-bound study which consisted of 26 cancer patients undergoing radiotherapy (13-oral cancer 13-laryngeal cancer). Subjects and Methods: Resting saliva samples were gathered from oral (Group-I) and laryngeal (Group-II) cancer patients immediately before radiotherapy and after completion of radiotherapy (dose-60 Gy). pH of saliva and the salivary flow rate was measured. S. mutans were analyzed using qRT PCR. Statistical Analysis Used: Data were analyzed using SPSS software 20. Paired t-test was used to evaluate salivary pH, flow rate, and amount of S. mutans pre- and post-radiotherapy for Group I and II. Independent t-test was used to compare salivary pH, flow rate, and S. mutans pre- and post-radiotherapy between Group I and II. Results: Salivary pH and flow rate significantly reduced postradiotherapy in oral and laryngeal cancer patients (P < 0.001). The amount of S. mutans statistically increased postradiotherapy in oral cancer patients (P = 0.001). While S. mutans count was statistically insignificant in laryngeal cancer patients (P = 0.091). There was a significant increase in the amount of S. mutans in Group I when compared with Group II (P = 0.002). Conclusion: Amount of S. mutans increased postradiotherapy in oral cancer patients. While the salivary pH and salivary flow rate reduced postradiotherapy.
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Improvement of petroselinum crispum on morphine toxicity in prefrontal cortex in rats
Mohammad Reza Salahshoor, Amir Abdolmaleki, Cyrus Jalili, Arash Ziapoor, Shiva Roshankhah
April-June 2020, 10(2):110-116
Background: Petroselinum crispum (P. Crispum) is an associate of the umbelliferae family with several therapeutic attributes. Morphine is known as a major risk factor in the development of functional disorder of several organs. Objective: This study was designed to evaluate the effects of P. Crispum extract against morphine-induced damage to the brain prefrontal cortex (PC) of rats. Materials and Methods: In this experimental study, 64 Wistar male rats were randomly assigned to 8 groups: Sham group, Morphine group, P. Crispum groups (50, 100, and 150 mg/kg), and Morphine + P. Crispum groups. Daily intraperitoneal treatment applied for 20 days. Ferric reducing/antioxidant power method was hired to determine the total antioxidant capacity (TAC). The number of dendritic spines was investigated by Golgi staining technique. Cresyl violet staining method was used to determine the number of neurons in the PC region. Furthermore, Griess technique was used to determine the level of serum nitrite oxide. Results: Morphine administration increased nitrite oxide levels and decreased TAC, density of neuronal dendritic spines and neurons compared to the sham group significantly (P < 0.05). In whole doses of the P. Crispum and Morphine + P. Crispum groups, the number of neurons and neuronal dendritic spines increased significantly while nitrite oxide level and TAC decreased compared to the morphine group (P < 0.05). Conclusion: It seems that the administration of P. Crispum extract protects the animals against oxidative stress and nitrite oxide, also improves some PC parameters including the number of neurons, and dendritic spines because of the morphine application.
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Effect of Vitamin K epoxide reductase complex 1 polymorphism on warfarin dose requirement among patients in tertiary care hospital
Sahana Hadihalli Veeregowda, Bhuvana Krishnaswamy, Sharath Balakrishna,
April-June 2020, 10(2):97-101
Background: Warfarin, anticoagulant is used for thromboembolic disorders. Inter-individual variation in clinical response to warfarin is due to various factors, including polymorphism of Vitamin K epoxide reductase complex 1 (VKORC1)-1639G>A. The aim of our study was to evaluate the effect of VKORC1 polymorphism on the maintenance dose of warfarin. Materials and Methods: Cross-sectional study conducted by the departments of Pharmacology, Cell Biology and Molecular Genetics on patients attending cardiology clinic, receiving warfarin for at least 2 months. Genomic deoxyribonucleic acid was extracted and genotyping was done by Polymerase Chain Reaction - Restriction Fragment Length Polymorphism. The correlation between VKORC1 gene polymorphism and warfarin maintenance dose was analyzed. Results: A total of 102 patients with a mean age of 47.72 ± 10.31 years, of which 58 (56.86%) were male. The frequency of VKORC1 G>A for GG, GA, and AA genotypes was 74.51%, 19.61%, and 5.88%, respectively. Variant allele AA was less frequent than the wild type. Mean weekly warfarin dose was 23.12 ± 8.08, 22.93 ± 8.21, and 15.6 ± 5.35 mg in patients with GG, GA, and AA genotypes, respectively. Patients with GG genotype required therapeutic dose compared to variant type (P = 0.001). Multiple stepwise regression model showed 26.3% variability in warfarin dose was due to VKORC1 genotype (R = 0.513, R2 = 0.263, adjusted R2 = 0.256, P = 0.0001). Conclusion: VKORC1 polymorphism alone influence 26.3% variability in warfarin dose and AA genotype patients required lower dose.
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Greig cephalopolysyndactyly syndrome with oral manifestations: A rare case report
Jiji V Unni, Deepak Daryani, KC Sreejan, PM Uthkal
April-June 2020, 10(2):140-142
Greig cephalopolysyndactyly syndrome (GCPS) is one of the autosomal dominant-inherited syndromes, caused by haploinsufficiency of the GLI3 gene. It is a rare, multiple congenital syndrome with an estimated rate of 0.009%. With the classic clinical triad of preaxial polydactyly with cutaneous syndactyly of at least one limb, hypertelorism, and macrocephaly, presumptive diagnosis of GCPS is made. The purpose of this article is to report a case of GCPS with emphasis on craniofacial and oral features.
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Diffuse endobronchial telangiectasia
Mohan Rudrappa, Laxmi Kokatnur
April-June 2020, 10(2):137-139
Hemoptysis is one of the most common reasons for seeking emergency care. Infections and malignancy are the leading causes of hemoptysis although caused by various other pulmonary and extrapulmonary conditions. Most causes are self-limiting and do not warrant any aggressive investigation. Endobronchial telangiectasia can rarely cause hemoptysis and is seen in patients with hemorrhagic hereditary telangiectasia or scleroderma. Isolated diffuse endobronchial telangiectasia is rare and is only reported in one case in literature. We present another case of diffuse endobronchial telangiectasia in a young adult who presented with recurrent hemoptysis. Computer tomography scan was normal, but bronchoscopy showed multiple endobronchial arteriovenous malformations in the entire tracheobronchial tree.
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Bilateral ectopic eruption of a maxillary third molar tooth from the infratemporal surface of the maxilla in a dry human skull
Syed Rehan Hafiz Daimi
April-June 2020, 10(2):131-133
Unilateral ectopic eruption in an infratemporal region (ITR) is rare and hardly documented a couple of times. However, the bilateral third molar in the ITR presented here is rarely described. ITR has a complex anatomy and is a house of many vital structures. Ectopic eruption of a tooth in this region may manifest in different ways depending on the effected anatomical structure. In this article, we report bilateral ectopic erupted third maxillary molar tooth that was found in a dry human skull. The tooth was partially erupted on both sides from the infratemporal surface of the maxilla, and the direction of the eruption was downward and laterally. The morphology and morphometric measurement of the ectopic tooth with the surrounding anatomical structures has been performed with the help of Vernier caliper. Knowledge of such rare anomalies may be helpful for the ear, nose, and throat and maxillofacial surgeon for the early diagnosis and treatment, hence avoiding the unnecessary hassle of the patient.
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