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   Table of Contents - Current issue
Coverpage
January-June 2019
Volume 6 | Issue 1
Page Nos. 1-49

Online since Monday, June 10, 2019

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EDITORIAL  

Validating biological research: Role of statistics p. 1
Sanjeev Kumar Jain, Umme Afifa, Sanya Jain, Sonika Sharma
DOI:10.4103/ami.ami_43_19  
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ORIGINAL ARTICLES Top

A comparative study of histopathological findings in psoriatic lesions with and without treatment p. 2
Deepti Arora, Faiyaz Ahmad, Ankita Mittal, Ashutosh Kumar, Seema Awasthi, Shyamoli Dutta
DOI:10.4103/ami.ami_19_19  
Background: Psoriasis is a multifactorial chronic relapsing inflammatory dermatological disorder associated with significant comorbidities. It is characterized by sharply demarcated, erythematous papules, and plaques with abundant silvery-white scales. Due to its variable clinical presentation, histopathology remains the mainstay of diagnosis. However, these histologic features changes with treatment and may also guide in therapeutic decision-making. Aim: The aim is to evaluate and compare the histopathological features of psoriatic lesions before treatment with those receiving treatment for psoriasis. Patients and Methods: A total of 101 biopsies from selected consecutive patients of histopathologically confirmed psoriasis vulgaris were included in the study. These cases were then divided into two groups, Group A includes cases who never received treatment and Group B, those receiving treatment for psoriasis. These biopsies were histopathologically analyzed and compared for various morphological features. Results: Of 101 cases of psoriasis, 72 cases were included in Group A and 29 were included in Group B. Biopsies of Group A showed parakeratosis and acanthosis as a common feature in all of them with dilated or abnormal capillary pattern in dermal papillae in 93.1%. In Group B, in spite of uniform parakeratosis as noticed in Group A biopsies, focal parakeratosis was seen in 83.3%, acanthosis in 87.5%, and dilated/abnormal capillary pattern in dermis was observed to be a universal feature in biopsies of Group B. All other microscopic features of psoriasis also decreased in frequency in Group B. However, statistically significant difference is seen only in changes in morphological features of superficial epidermis that is, parakeratosis, acanthosis, and absent or decreased granular layer in both the groups. Conclusion: Treatment may lead to improvement in the histologic features in epidermis with significant difference in few of them. However, abnormal vasculature in the dermal papillae persists and does not show any improvement with therapy.
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Lymph node biopsies: Evaluation of disease pattern and role of surgery – Our experience from South Punjab, Pakistan p. 7
Muhammad Irshad Hussain, Mulazim Hussain Bukhari, Muhammad Zeeshan Aftab
DOI:10.4103/ami.ami_62_18  
Objective: The objective of the study was to determine the frequency of different pathologies presenting with lymphadenopathy in patients from South Punjab and to evaluate the role of surgery in reaching the diagnosis. Materials and Methods: It was a cross-sectional study done at Recep Tayyip Erdogan Hospital, Muzaffargarh (managed by The Indus Health Network), from August 2014 to October 2017. Those being biopsied at some other hospital and the lymph node dissection biopsy done for a known primary cancer were excluded. Results: Lymph node biopsy was done on a total of 71 patients (56.3% n = 40 males, 43.7% n = 31 females). The mean (standard deviation) age of the patients was 27.30 ± 17.07 years. Open biopsy was performed on 70 cases (98.6%), whereas laparoscopic biopsy was performed on one case (1.4%). The most common pathology found on histopathology report was Tuberclosis (TB) lymphadenitis (49.3%, n = 35), followed by lymphoma (25.4% – Hodgkin's disease [HD] 15.5% and non-Hodgkin's lymphoma [NHL] 9.9%). Conclusion: TB is the most common pathology, followed by lymphoma. HD is more common than NHL. Surgical biopsy is the gold standard. Laparoscopy and other minimally invasive techniques are very safe and useful for excision biopsy of the central lymph nodes.
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Thyroid-stimulating hormone in hypothyroidism – How high is too high? p. 11
Ruth Priya Senthiappan, Smitha Bhat, Sudeep Krishna
DOI:10.4103/ami.ami_76_18  
Background: The prevalence of hypothyroidism in the developed world is about 4-5% and in India is 10.9%. The goal of treating hypothyroidism is to maintain thyrotropin (TSH) levels within the normal reference range. Studies have shown that even within the normal range of TSH, patients with low normal TSH (LNT) have better outcomes when compared to patients with high normal TSH (HNT). Aims and Objectives: Our study aimed to find whether patients treated at a dose of levothyroxine resulting in an LNT had improved clinical outcomes and biochemical parameters, when compared to those on a levothyroxine dose resulting in an HNT. Materials and Methods: 180 patients with hypothyroidism on treatment, who had a TSH of 0.27-4.2mIU/L and had been on treatment with a stable dose of at least 50 micrograms of levothyroxine for at least 6 months were administered the Thyroid Symptom Questionnaire. TSH was assayed. Blood pressure and BMI were measured. Serum lipids were measured by spectrophotometry. Results: We found that patients with LNT and HNT did not differ with respect to cognitive symptoms , feelings of coldness, lethargy and fatigue. However, patients with LNT had a better lipid profile (mean LDL 132.24 in HNT and 115.39 in LNT p= 0.08) and lower BMI (1.045kg/m 2 lower in LNT compared to HNT) compared to HNT. Conclusion: Treating patients with a dose of thyroxine titrated to achieve LNT might decrease the cardiovascular risk by improving the lipid profile and BMI.
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Acceptance of immunization by caregivers of children attending a tertiary health facility in Northwestern Nigeria p. 17
Ibrahim Aliyu, Abdulsalam Mohammed, Halima Umar Ibrahim, Yohanna Bitrus Ghidazuka
DOI:10.4103/ami.ami_3_19  
Introduction: Immunization against childhood diseases is well received in most developed countries; also, countries in the Caribbean and Latin America have attained over 90% immunization coverage unlike the most sub-Saharan African countries, such as Nigeria, which have a dismally low coverage. Our objective is, therefore, to determine the acceptance and willingness to complete immunization of children by caregivers seen in our health facility. Materials and Methods: This study was cross sectional involving caregivers attending the pediatric outpatient clinic of Aminu Kano Teaching Hospital, Kano, Nigeria, during the month of December 2017. This was questionnaire based and was administered by the researchers and trained assistants. It contained 20 questions consisting of both open- and close-ended questions. Results: All respondents were aware of the childhood immunization program and were willing to accept all vaccines for their children. They all believed that immunization was beneficial to their children; 126 (79.7%) respondents could correctly state the advantages of childhood immunization. However, only 18 (11.4%) of the respondents could correctly list the names of the childhood vaccines in the National Programme of Immunization. About 33.5% of respondents reported six visits as the total number of visits for childhood immunization; higher proportion of health workers and those with tertiary educational qualification could correctly list the names of the vaccines given to their children, and these observations were statistically significant (Chi-squared test = 27.786, df = 1, P = 0.000; Fisher's exact test = 12.421, P = 0.004). Conclusion: This study showed that most respondents were willing to accept and complete the immunization schedule; however, there was a significant knowledge gap, especially in listing the names of the vaccines and the expected number of immunization visits.
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The jefferson scale of physician empathy: A preliminary study of validity and reliability among physicians in Nigerian tertiary hospital p. 22
Juliet Hodo Osim, Emmanuel Aniekan Essien, Joseph Okegbe, Owoidoho Udofia
DOI:10.4103/ami.ami_70_18  
Introduction: Physician empathy has been shown to have a substantial effect on doctor–patient relationship, therapeutic adherence, and overall treatment outcome. Despite its important role, physician empathy is under-researched in Nigeria. Aims: This study aims to investigate the validity and reliability of the Jefferson Scale of Physician Empathy (JSPE) (Health Professional version) among Nigerian physicians in the University of Uyo teaching hospital, Uyo, Nigeria. Participants and Methods: In this cross-sectional study, a brief sociodemographic questionnaire, the Emotional intelligence scale (EIS), and the JSPE were administered to 120 doctors in the University of Uyo teaching hospital. Data were analyzed using SPSS version 22. Results: Cronbach's and split half coefficients were 0.73 and 0.66, respectively. Correlation coefficient with the EIS was 0.49 (P < 0.05). Exploratory factor analysis yielded three factors that were not quite consistent with previous reports. We found empathy to be significantly higher among older physicians, those who were involved in administrative duties and those with a higher rank (P < 0.05). After regression analysis, age, sex, and administrative role emerged as significant predictors of physician empathy (P < 0.05). Conclusions: The JSPE had fairly strong reliability coefficients and an acceptable convergent validity with the EIS which measures a related construct. It can serve as a useful measure of patient-related empathy among Nigerian doctors.
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Personality traits of young men with different diplotypes p. 28
Pavel N Ermakov, Elena V Vorobyeva, Ekaterina M Kovsh, Irina V Abakumova, Olga D Fedotova, Marina P Aralova, Wladimir W Latun, Lubov Ya Horonko
DOI:10.4103/ami.ami_49_18  
Background: Historically in psychogenetic research the attention has been paid to describing personality traits of the carriers of some sole genotypes; but in this work the characteristic traits of carriers of catecholaminergic system MAOA and COMT genes' genotypes different combinations are presented. Methods: A psychodiagnostic toolkit included 7 types of inventories. Genotyping was conducted with the help of DNA extraction from the buccal epithelium cells with subsequent PCR diagnostics and 3 types of statistical processing. Results: It was shown that carriers of a highly active diplotype have the lowest level of aggressiveness and are inclined to cooperate in the conflict; carriers of the highly active genotype MAOA in combination with the heterozygous genotype COMT have an average level of aggressiveness and high rates of emotional lability; carriers of low-level MAOA in combination with heterozygous genotype COMT have the highest rates of motivation to achieve success and verbal aggression; carriers of low-level MAOA and highly active COMT are emotionally labile and non-aggressive. Conclusion: We conclude that male carriers of a low-active diplotype have the highest level of aggressiveness and disposition to addictive behavior, which may indicate the association of this diplotype in a sample of young Russian men with social disadaptation.
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Bedroom design orientation and sleep electroencephalography signals p. 33
Amin Hekmatmanesh, Maryam Banaei, Khosro Sadeghniiat Haghighi, Arezu Najafi
DOI:10.4103/ami.ami_60_18  
Background: Orientation is a significant factor in architectural design that may affect well-being. Body direction does not change during sleeping, and sleeping is sensitive and affected by environmental factors. Aims: This neuroarchitecture study aimed to assess the effects of bed orientation on sleep quality to enhance bedroom design. Materials and Methods: To do so, the effects of earth's electromagnetic field (EMF) on sleep electroencephalography (EEG) signals were evaluated using signal processing techniques. In this cross-sectional study, a total of 21 healthy volunteer participants slept for two consecutive naps, at two rooms with identical interior design and different bed orientations, toward and against earth's EMF in a sleep clinic. Statistical Analysis: In this experiment, discrete wavelet transform extracted five subfrequencies of EEG data as delta, theta, alpha, beta1, and beta2. In addition, the energy signals were computed by measurement of wave frequencies. The mean total sleep time was 1.63 h in North–South (N-S) earth's EMF orientation and 1.38 h in the other direction. Results: t-test results showed significant changes in delta, theta, and alpha frequencies in terms of bed orientation. There was a significant result in the alpha energy ratio over the whole signal energy. Furthermore, there were increases in the average energy of delta, theta, and alpha bands in N-S versus East–West (E-W) bed directions. Conclusions: This study indicated that sleep in N-S direction could be more beneficial than E-W and the sleep EEG signals can be sensitive to earth's EMF. The results show the importance of considering orientation in bedroom design and its benefits on inhabitants' well-being.
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Evaluation of “point of care” brain natriuretic peptide level in differentiating between cardiogenic and noncardiogenic acute dyspnea (a hospital-based study) p. 38
Priyanka Singh, Shubham Prasad, Lalit P Meena, Jaya Chakravarty, Madhukar Rai
DOI:10.4103/ami.ami_96_18  
Introduction: Acute dyspnea is one of the most common reasons for admission to emergency rooms. It could be due to potentially life-threatening cardiac or respiratory conditions. Differentiation among these three disorders is frequently needed. In the condition of heart failure, where there is clinical need for early and appropriate treatment but no objective method for rapid diagnosis, the potential benefits are enormous for any biomarker that can reliably rule in or rule out this syndrome. Objectives: The objectives of this study are as follows: (i) To evaluate the role of point of care of brain natriuretic peptide (BNP) in acute dyspnea and (ii) To determine the cutoff level of BNP to differentiate between cardiogenic and noncardiogenic causes of dyspnea. Materials and Methods: This was an in-hospital cross-sectional study conducted at a tertiary care center. Patients were evaluated using predetermined performa. All these patients were subjected to routine blood investigations, digital chest X-ray, and 12-lead electrocardiography. At the same time point of care, BNP was done in each patient after obtaining informed written consent. All patients with BNP >100 or clinical suspicion for heart failure underwent two-dimensional echocardiography (ECHO) with color Doppler. Results: A cross-sectional study was conducted on 238 patients presenting with acute dyspnea. Almost all patients with BNP level >415 pg/ml had <45% ejection fraction, but patients with BNP level <415 pg/ml had echocardiographic findings not suggestive of heart failure. Conclusion: This study gives us a reliable cutoff level of 415 pg/ml of BNP which clearly distinguishes between cardiogenic versus noncardiogenic dyspnea.
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CASE REPORTS Top

Treatment-emergent dhat syndrome in a young male with Obsessive–Compulsive disorder: An alarm for medication nonadherence p. 44
Sujita Kumar Kar
DOI:10.4103/ami.ami_82_18  
Dhat syndrome refers to a culture-bound syndrome of Southeast Asia, where patients present with anxiety and depressive and somatic symptoms, which they attribute to semen loss. Common presentation of these patients is the passage of semen-like substance in urine. Retrograde ejaculation may cause spermaturia, and patients with firmly held cultural myths related to sexuality may develop features of Dhat syndrome. Here, a patient with obsessive–compulsive disorder on treatment with fluoxetine developed retrograde ejaculation and subsequently features of Dhat syndrome.
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Cerebral vein thrombosis due to meningococcal meningitis p. 46
Atousa Hakamifard, Helia Hemasian
DOI:10.4103/ami.ami_67_18  
Bacterial meningitis is a life-threatening condition and Neisseria meningitidis is a major cause. Cerebrovascular complications can occur. Cerebral venous and sinus thrombosis (CVST) is an uncommon type of these complications, especially in meningococcal meningitis. The initiation of anticoagulant in septic thrombosis is controversial. A 35-year-old man was admitted to a hospital with fever and confusion. The diagnosis of N. meningitidis meningitis was established. Antimicrobial regimen (ceftriaxone) was continued. On the 3rd day, the patient's consciousness was improved; however, according to the patient's headache on day 7, brain imaging was performed which revealed a cerebral thrombosis in transverse and sigmoid sinuses. Although initiation of anticoagulant is controversial in septic thrombosis, the anticoagulant treatment also was started. Control brain magnetic resonance venogram done revealed complete resolution of cerebral CVST after 2 weeks. CVST as a complication of meningococcal meningitis should be considered. Anticoagulant treatment may be considered in the management of septic cerebral thrombosis if there are no contraindications. The use of anticoagulant needs further studies.
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LETTER TO EDITOR Top

Ending the tuberculosis epidemic: Necessity to bridge the existing gaps p. 49
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/ami.ami_64_18  
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