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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 6 | Issue 2
Page Nos. 51-100

Online since Monday, November 18, 2019

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EDITORIAL  

Statistical need of the hour p. 51
Sanjeev Kumar Jain, Nidhi Sharma, Sonika Sharma
DOI:10.4103/ami.ami_85_19  
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ORIGINAL ARTICLES Top

Impact of CD40 gene polymorphism on coronary artery disease in an Indian population: A pilot study p. 53
Sapna Singh, Manisha Naithani, Sarama Saha
DOI:10.4103/ami.ami_54_19  
Context: Coronary artery disease (CAD) is number one killer in India. CD40/CD40 L may have crucial contribution in the development of CAD because of its dual prothrombotic and proinflammatory role. However, no study has been conducted to observe the effect of CD40 gene polymorphism on CAD in Indian populations. Aims: To determine the allelic frequency of CD40 gene and its influence on Indian individuals having unstable chest pain and cardiac muscle infarction which are variants of CAD. Settings and Design: A clinic-based observational study was conducted in Maulana Azad Medical College. Eighty angiographically proven patients of CAD and fifty healthy individuals registered for this study. Materials and Methods: Polymerase chain reaction and restriction fragment length polymorphism were used for studying CD40 gene polymorphism. Statistical Analysis Used: Frequency distribution of genotype was analyzed by standard Chi-square test using SPSS software version 21. Results: The C and T allele frequencies were 71.25% and 28.75%, respectively, in diseased individuals. Significant difference was observed among patients with CAD and healthy references regarding distribution of genotypes (χ2 = 10, P = 0.007) although allele frequencies (χ2 = 2.94, P = 0.09) of CD40 gene did not show any significance. The presence of C allele augmented the chance of having CADs compared to the wild type (odds ratio: 1.13; 95% confidence interval: 0.687–1.887). Conclusions: Important correlation was noted between rs1883832 C/T polymorphism of CD40 gene and risk of development of CADs among Indian populations.
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Oxidative stress and biomarker of tumor necrosis factor-alpha, malondialdehyde, and ferric reducing antioxidant power in hypertension p. 58
Manish Kumar Verma, Anoop Jaiswal, Preeti Sharma, Pradeep Kumar, Anand Narayan Singh
DOI:10.4103/ami.ami_34_19  
Background: Concurrent with the imbalance of oxidizing agents and antioxidants, high blood pressure (BP) is a major physical condition burden in the current scenario. Tumor necrosis factor-alpha (TNF-α) plays a vital role in the pathogenesis of hypertension (HTN). TNF-α inhibitor improves clinical symptoms; however, their outcome on high BP has not been investigated. We investigated the inflammatory marker TNF-α, malondialdehyde (MDA), and ferric reducing antioxidant power (FRAP) in hypertensive patients. We measured BP randomly using an ambulatory observe in hypertensive patients. Measured systolic BP was 140 mmHg and/or diastolic BP was 90 mmHg were considered hypertensive. Materials and Methods: A total of 60 cases were considered in the study involving 30 hypertensive patients and 30 normal controls (30). Measurements of serum concentrations of TNF-α, MDA, and FRAP in HTN patients were done in both the groups. Results: Serum TNF-α was found to be remarkably increased in study participants as compared to the normal group (r = 0.32,P < 0.0001*). Serum MDA was also raised in hypertensive as compared to the control group (r = 0.99**,P < 0.0001*), whereas serum FRAP was found to be decreased in the hypertensive group in comparison to the healthy controls (r = 0.23,P < 0.0001*). Conclusions: It is concluded that high BP leads to the generation of oxidative stress with a remarkable elevation of TNF-α and MDA levels. The indicates decrease level of Ferric Reducing Antioxidant Power (FRAP) and suggest a possible role of oxidative stress in the pathophysiology of hypertension.
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Assessment of vital respiratory indices of petrol pump workers of Kathmandu p. 65
Rajan Pandit
DOI:10.4103/ami.ami_21_19  
Introduction: Petrol pump is a place where workers are exposed to both fuel vapor and the vehicular exhaust fumes. Automobile exhaust, a complex mixture of different gasses such as sulfur dioxide, carbon dioxide, carbon monoxide, nitrogen dioxide, and particulate matter, has an adverse impact on the respiratory system. The present cross-sectional study, therefore, has been designed to determine the few vital respiratory indices of petrol pump workers. Methods: Forty nonsmoker petrol pump workers and other forty participants, as a control group from the same locality, were considered in this study. All inclusion and exclusion criteria were followed. After participants were familiarized with spiro-excel (PC bases) spirometer, they were asked to perform maneuver – a forced expiratory following full inspiration – until they could duplicate the maneuvers successfully on three consecutive attempts. Parameters such as forced vital capacity (FVC), forced expiratory volume in the 1st s (FEV1), FEV1/FVC (%), peak expiratory flow rate (PEFR), and forced expiratory flow at 25%–75% (FEF25%–75%) were recorded in sitting position preceded by 5-min rest, and the best values of three attempts were considered for data analysis using SPSS 16.0 version, and t-test (P < 0.05) was used for statistical analysis. Results: The mean ± standard deviation values of FVC, FEV1, FEV1/FVC (%), FEF25%–75%, and PEFR for petrol pump workers versus control groups were 3.44 ± 0.23 versus 3.94 ± 0.25 L, 2.64 ± 0.20 versus 3.24 ± 0.29 L, 77.11% ± 0.08% versus 82.61% ± 0.09%, 4.36 ± 0.37 versus 5.58 ± 0.36 L/s, and 6.35 ± 0.27 versus 7.62 ± 0.45 L/s, respectively. Conclusion: The significant decrease in FVC, FEV1, FEV1/FVC (%), FEF25%–75%, and PEFR in this study showed that long-term exposure to gasoline fumes/products leads to inflicted changes in lungs functions and could result to obstructive lung disease.
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Clinical profile and maternal depression and anxiety in children and adolescents with intellectual disability: A study from outpatient child psychiatry Highly accessed article p. 68
Bilal Ahmad Bhat, Shabir Ahmad Dar, Wasim Qadir, Mudassir Hassan Pandith
DOI:10.4103/ami.ami_25_19  
Background: With prevalence between 1% and 3%, intellectual disability (ID) not only affects the children and adolescents with this disability but also the caregivers, particularly the mothers. Aims: The aim was to study the clinical profile of children and adolescents with ID along with the prevalence of depressive and anxiety disorders in their mothers. Settings and Design: Cross-sectional descriptive study was conducted in Outpatient child psychiatry clinic. Methodology: Children and adolescents diagnosed with ID by a psychiatrist and clinical psychologist where subjected to a semi-structured questionnaire to record the sociodemographic status, antenatal history, perinatal history, and developmental history, presenting complaints, current behavioral problems, and medical history. Psychiatric comorbidity in the study participants and depression and anxiety disorders in their mothers was also assessed. Results: With the mean age of 8.68 years ± 2.63, majority (81.2%) belonged to the age group of 6–12 years with predominance of boys (60%). Antenatal factors were present in about 18%, whereas perinatal factors were present in about 48%. Delayed developmental history was present in 75%. Psychiatric comorbidity was present in about 32%, whereas current behavioral problems were present in about 47%. Majority (about 71%) had mild ID. Maternal depression and anxiety disorders were present in about 70%. Statistical Analysis: Descriptive analysis was performed with the Statistical Package for the Social Sciences. Conclusion: High rates of antenatal and perinatal factors with a history of developmental delay in a significant number of children and adolescents with ID were found. Mild ID predominated. Behavioral problems, psychiatric comorbidity, and medical comorbidity were frequently observed. Maternal depression and anxiety were also very high.
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Prevalence of different types of sphenoid sinus pneumatization in the Indian population: A noncontrast computed tomography-based study p. 74
Abdul Haseeb Wani, Arshed Hussain Parry, Imza Feroz, Naseer Ahmad Choh, Tariq A Gojwari
DOI:10.4103/ami.ami_29_19  
Background: Trans-sphenoidal approach for various surgical interventions of sella and suprasellar pathologies is fraught with the risk of injuring vital neurovascular structures which lie nearby. Preoperative knowledge of the pattern of sphenoid sinus pneumatisation is of paramount importance to anticipate and simultaneously undertake appropriate precautions to avert any complication. Objective: To determine the prevalence of different types of sphenoid sinus pneumatisation in our population. Materials and Methods: NCCT head images of 613 patients were analysed retrospectively to determine the type of sphenoid sinus pneumatisation. Individuals in the age range of 20 to 75 years were included in the study. Individuals with age less than 20 years (pneumatisation incomplete), previous surgery involving skull base/sphenoid sinus and trauma causing hemo-sinus/fractures around skull base or having space occupying lesions around skull base/sphenoid sinus were excluded from the study. Results: The age range of evaluated patients was 20 to 75 years with mean age of 45.67 years of which 368 (60.03%) were males and 245 (39.97%) were females. There was no significant statistical difference in the prevalence of various types of sphenoid sinus pneumatisation between male and female subjects (P-value >0.05). The commonest type of sphenoid sinus pneumatisation was post-sellar type (82.71%) followed by sellar (14.68%) and pre-sellar (2.45%) type. Conchal type was extremely rare. Conclusions: Preoperative computed tomographic (CT) evaluation of sellar region is a requisite whenever trans-sphenoidal surgery is contemplated to determine the location and extent of sphenoid sinus walls to shorten operative time and to minimize morbid consequences.
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Determination of the gallbladder wall thickness in patients with cholecystitis and cholelithiasis by ultrasonography in North Indian population p. 78
Vishram Singh, Durgesh Singh, Ashutosh Tandon, Yogesh Yadav, Richa Tiwari
DOI:10.4103/ami.ami_33_19  
Objective: The objective of the study was to determine the gallbladder (GB) wall thickness in patients with cholecystitis and cholelithiasis with the help of ultrasonography in North Indian population for the estimation of epidemiology. Aim: The aim was to estimate epidemiology of the GB wall thickness in patients with cholecystitis and cholelithiasis by ultrasonography in North Indian population. Materials and Methods: This was a hospital-based case–control study. Patients with cholecystitis and cholelithiasis of age between 15 and 70 years of either sex were included in the study. The GB wall thickness was determined in the fasting state. A total of 50 samples, 36 cases (with diseased bladder) and 14 controls (with normal bladder) were included in the study. Results: More than one-third of cases (38.9%) were between 30 and 40 years. The mean age of cases and controls was 42.22 ± 12.81 and 35.43 ± 11.85 years, respectively. More than one-third of both cases (36.1%) and controls (35.7%) were males. The GB wall thickness was significantly (P = 0.005) higher among the cases (4.06 ± 2.28 mm) than that of controls (2.22 ± 0.67 mm). Full distention of the GB was in more than half of both cases (69.4%) and controls (57.1%). Partial distended was in 11.1% of cases and in 21.4% of controls. Contracted (8.3%) and overdistended (2.8%) were only seen among cases. The GB wall thickness of ≥3 mm was among 66.7% of patients and in 14.3% of controls. The GB wall thickness of <3 mm was 92% lower in cases compared to controls (odds ratio = 0.08, 95% confidence interval = 0.01–0.43, P = 0.001). Conclusion: During ultrasonography, a higher degree of the GB wall thickness was found in patients with cholecystitis and cholelithiasis as compared to the control group.
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Role of a noninvasive stool-based molecular test in screening and early detection of colorectal cancers p. 82
Khalid Ahmad Al-Sindi, Mulazim Hussain Bukhari, Mohmed Ali Al-Hamar
DOI:10.4103/ami.ami_27_19  
Background: Colonoscopy is considered the gold standard for most currently established screening programs for colorectal carcinoma (CRC), but due to its invasive nature, there were several emerging needs for the use of a substitutive, sensitive, non-invasive triaging modalities, such as utilizing immunochromatographic fecal occult blood tests (IFOBT) or molecular stool based tests such as Glycolytic M2-Pyruvate Kinase (M2-PK). Objectives: Firstly, to evaluate the sensitivity of a molecular stool based (M2PK) test, as a non-invasive, screening modality for detecting CRC and other colorectal disease (CRD). Secondary, to insight the current prevalence of CRC precursors in the Kingdom of Bahrain and recommend a customized age of enrollment in National Screening Program for CRC, once established and Thirdly, to compare the sensitivity of this fecal tumor marker based M2-PK test, as a potential replacement for the currently used IFOB test, in an attempt to promote for the need to establish a National Screening Program for Colorectal Cancer (NSPCC) based on such molecular based test or a similar platform in the kingdom, much comparable to the currently established international screening programs. Design: Prospective, cross sectional study. Duration and Place of Study: July 2012-December 2016, King Hamad University Hospital (KHUH), Bahrain. Sample Size: 2,100 (Based on Bahrain Population statistics: 1,248.348. Materials and Methods: The stool samples were collected shortly after launching a nationwide public awareness campaign against CRD in all major governmental and private sector hospitals and clinics. Out of the intended 2100 target samples, 1074 individuals managed to go through the well-structured distributed questioner and have been selected according to the inclusion/exclusion criteria and submitted their stools' samples for the detection of any CRD. A combined (molecular M2-PK and IFOBT) stool tests were used to detect any CRD in all examined stool samples. A total of 105 M2-PK' positive and 85 M2-PK'negative individuals underwent a subsequent specialist consultation and a fast track colonoscopy. Results: Out of the intended 2100 study sample, 1552 Participants were obtained during the study period and out of those, 1199 have been selected based on the inclusion and exclusion criteria. The no-show selected participants were 624 and only 575 individuals have submitted their Stool samples along with fully completed questioners. Out of those 575, only 287 stool samples were positive with M2-PK test, while 197 of the same stool samples were positive with IFOBT. Among these positive cases, only 105 of participants agreed after their medical consultation to undergo for full colonoscopies and biopsies for microscopic examination. These 105 successful full colonoscopies reveled 85 (81%) individuals negative for any neoplastic lesion and only 20 individuals (19%) showed neoplastic lesion. These 20 neoplastic findings included, 17 (85%) adenomatous polyps, 02 (10%), adenocarcinomas, and 01 (5%) was neuroendocrine carcinoma. The 17 adenomatous polyps were 09 tubular adenomas, 01 villous adenoma, and 07 tubulovillous adenomas. The colonoscopy findings in those (85) negative cases for neoplastic lesion were (6) hemorrhoids, (13) hyperplastic polyps, (10) normal mucosae with normal biopsies, (9) diverticulosis, (1) angiodysplasia, (1) inflammatory bowel disease and (1) solitary rectal ulcer. Conclusion: The screening of CRC by Stool Based molecular test such M2-PK showed high sensitivity for the detection of neoplastic Colorectal lesions compared to IFOBT. The study also found that stool based molecular (M2-PK) test, is a rapid, non-invasive, and convenient technique, which can be used as a platform for a forthcoming CRC National Screening Program in the Kingdom of Bahrain.
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Functional reach test: Establishing the reference value in healthy adults of Gujarat, India p. 89
Vyoma Bharat Dani, Riki Shah, Rima Sheth
DOI:10.4103/ami.ami_81_18  
Context: Functional reach test (FRT) is a quick and simple, single-task dynamic test to measure the balance of an individual during functional task and is considered to be a predictor of fall in older adults. There is a lack of availability of data from a large population-based study, especially in India. Aim: The aim of the present study is to establish the reference value for FRT in healthy adults of Gujarat, India. Materials and Methods: It was a cross-sectional, observational study. Five hundred and twenty-one healthy individuals, aged 40–70 years, were recruited based on convenience sampling. All the participants were made to perform FRT in a controlled environment in community. Three readings of the actual test were obtained and averaged. Results: Data were analyzed with mean, standard deviation, confidence intervals (confidence interval 95%), and Pearson's correlation coefficient (r) with α = 0.05 by the age groups (40–50, 51–60, 61–70 years) and gender. The mean FRT value for healthy adults of Gujarat (age 40–70 years) was found to be 34.94 ± 3.9 cm and 33.43 ± 3.69 cm for males and females, respectively. It also showed significant negative correlation with weight and body mass index and also demonstrated age-related decline for both male and female participants. Conclusion: The reference value for FRT in healthy adults was found to be 34.18 (±3.79) cm. These large population-based data can be used as a reference with a specific age group considering due variability with regards to age, sex, anthropometric measures, genetics, and geographical changes.
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CASE REPORTS Top

Robotic-assisted radical adrenalectomy for large adrenocortical carcinoma p. 93
Altaf Khan, Vinit Kumar Singh, Muhammed A P. Manzoor, M Mujeeburahiman, Nischith Dsouza
DOI:10.4103/ami.ami_71_18  
Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignancy with poor prognosis. Laparoscopic adrenalectomy has been a favorite surgical approach for the treatment of adrenal masses. The use of robotic-assisted surgery is the latest development for minimally invasive surgical management of adrenal masses. Here, we describe a rare case of ACC in a 51-year-old male patient who presented with pain in the lumbar region, and robot-assisted laparoscopic radical adrenalectomy was successfully performed transperitoneally with the assistance of the da Vinci robotic system. We also discuss the summary of clinical features of ACC. Robot-assisted laparoscopic adrenalectomy is safe, is easier with lesser blood loss, and is comfortable to the patient due to its low complication rates. The patient improved after tumor removal.
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Achalasia in a child confirmed by high-resolution manometry p. 96
Anirban Chatterjee, Sujitesh Saha
DOI:10.4103/ami.ami_14_19  
Achalasia is a primary motor disease of the esophagus. It is rare in the pediatric population; fewer than 5% of patients are below 15 years of age. Progressive dysphagia is the most common presentation in adults. The clinical presentation in children does differ from adults. The various clinical features are nocturnal cough, recurrent pneumonia, vomiting, and feeding difficulties. The symptoms of achalasia may mimic gastroesophageal reflux disease in children. We report a 4-year-old boy presented with increasing difficulty in swallowing. Esophagram showed a smooth narrowing of the distal end and dilated esophagus. High-resolution manometry (HRM) had confirmed the diagnosis by fulfilling the criteria for achalasia Type 2. HRM has high sensitivity than conventional and may predict prognosis. He underwent Heller's myotomy with an anti-reflux procedure. The patient was asymptomatic after curative surgery. We report a rare case of achalasia in a 4-year-old boy confirmed by novel diagnostic technique HRM; hence, pediatric data of HRM are limited.
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LETTER TO EDITOR Top

The need for a balanced scorecard to monitor hospital performance p. 99
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/ami.ami_17_19  
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