International Journal of Research in Medical Sciences <p>International Journal of Research in Medical Sciences (IJRMS) is an open access, international, peer-reviewed general medical journal. The journal's full text is available online at The journal allows free access to its contents. International Journal of Research in Medical Sciences is dedicated to publishing research in medical science from all disciplines and therapeutic areas of medical science or practice. The journal has a broad coverage of relevant topics across medical science or practice. International Journal of Research in Medical Sciences (IJRMS) is one of the fastest communication journals and articles are published online within short time after acceptance of manuscripts. The types of articles accepted include original research articles, review articles, editorial, medical news, case reports, adverse drug reactions, short communications, correspondence, images in medical practice, clinical problem solving, perspectives and new drug updates. It is published <strong>monthly</strong> and available in print and online version. International Journal of Research in Medical Sciences (IJRMS) complies with the uniform requirements for manuscripts submitted to biomedical journals, issued by the International Committee for Medical Journal Editors.</p> <p><strong>Issues: 12 per year</strong></p> <p><strong>Email:</strong> <a href="" target="_blank" rel="noopener"></a>, <a href="" target="_blank" rel="noopener"></a></p> <p><strong>Print ISSN:</strong> 2320-6071<br /><strong>Online ISSN:</strong> 2320-6012</p> <p><strong>Publisher:</strong> <a href="" target="_blank" rel="noopener"><strong>Medip Academy</strong></a></p> <p><strong>DOI prefix:</strong> 10.18203</p> <p>Medip Academy is a member of Publishers International Linking Association, Inc. (PILA), which operates <a href="" target="_blank" rel="noopener">CrossRef (DOI)</a></p> <p> </p> <p><strong>Manuscript Submission</strong></p> <p>International Journal of Research in Medical Sciences accepts manuscript submissions through <a href="" target="_blank" rel="noopener">Online Submissions</a>:</p> <p>Registration and login are required to submit manuscripts online and to check the status of current submissions.</p> <ul> <li><a href="" target="_blank" rel="noopener">Registration</a></li> <li><a href="" target="_blank" rel="noopener">Login</a></li> </ul> <p>Please check out the video on our YouTube Channel:</p> <p>Steps to register and submit a manuscript:<br /><a href="" target="_blank" rel="noopener"></a></p> <p>Problem Logging In-Clear cookies:<br /><a href="" target="_blank" rel="noopener"></a></p> <p>If you find any difficulty in online submission of your manuscript, please contact editor at <a href="" target="_blank" rel="noopener"></a>, <a href="" target="_blank" rel="noopener"></a></p> <p><strong> </strong></p> <p><strong>Abbreviation</strong></p> <p>The correct abbreviation for abstracting and indexing purposes is Int J Res Med Sci.</p> <p><strong> </strong></p> <p><strong>Abstracting and Indexing information</strong></p> <p>The International Journal of Research in Medical Sciences is indexed with</p> <ul> <li><a title="PubMed and PubMed Central (PMC)" href="" target="_blank" rel="noopener">PubMed and PubMed Central (PMC)</a> (NLM ID: 101772888, Selected citations only)</li> <li><a href=";journalId=31374" target="_blank" rel="noopener">Index Copernicus</a> </li> <li><a href="" target="_blank" rel="noopener">Index Medicus for South-East Asia Region (WHO)</a></li> <li><a title="Scilit" href="" target="_blank" rel="noopener">Scilit (MDPI)</a></li> <li><a href="" target="_blank" rel="noopener">ScopeMed</a></li> <li><a href="" target="_blank" rel="noopener">CrossRef</a></li> <li><a href="" target="_blank" rel="noopener">Google Scholar</a></li> <li><a href="" target="_blank" rel="noopener">Ulrichsweb</a></li> <li><a href="" target="_blank" rel="noopener">Journal Index</a></li> <li><a href="" target="_blank" rel="noopener">J-Gate</a></li> <li><a href="" target="_blank" rel="noopener">Directory of Science</a></li> <li><a href="" target="_blank" rel="noopener">JournalTOCs</a></li> <li><a href=";issn=23206071&amp;uid=r0eec0" target="_blank" rel="noopener">ResearchBib</a></li> <li><a href="" target="_blank" rel="noopener">ICMJE</a></li> <li><a href=";fIDnum=|&amp;mode=simple&amp;letter=ALL&amp;la=en" target="_blank" rel="noopener">SHERPA/RoMEO</a></li> </ul> <p> </p> en-US (Editor) (Editor) Fri, 29 Mar 2024 19:46:05 +0530 OJS 60 Yolk sac tumor in children and the resulting biopsychosocial and spiritual aspects <p>Yolk sac tumor is a rare germ cell tumor in children, accounting for only about 3.5% of pediatric cancers. However, the yolk sac tumor is a malignant tumor that requires chemotherapy, but the side effects of chemotherapy can have an impact on the biopsychosocial and spiritual aspects of the child. This case report presents the negative impacts on the biopsychosocial and spiritual aspects of a child diagnosed with a yolk sac tumor. 11-year-old girl experienced symptoms of an enlarged abdomen, feeling bloated, pain, and frequent urination. The pathological examination revealed a yolk sac tumor, and the examination of ascites showed malignant cells. The patient was diagnosed with a yolk sac tumor, Stage 1C3, and was to undergo chemotherapy. She scored 15, indicating that the patient experienced anxiety due to the yolk sac tumor diagnosis and was anxious about the side effects of chemotherapy. Examination of the biological, psychological, social, and spiritual aspects in pediatric patients with a yolk sac tumor can assist in addressing the adverse effects of the diagnosis and the anxiety about chemotherapy in a more comprehensive manner.</p> Hidayatullah, Irma Savitri, Lenny M. Lisal Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Amyand's hernia: an uncommon entity <p>A 60-year-old male case whose condition began 6 months prior to admission to the emergency department, presenting an increase in volume in the right inguinal region, with intermittent pain, colic type, with an intensity rating of 8-10/10. On physical examination we found increased volume in the right inguinal region when standing, tumor measuring approximately 5x5 cm, hernia defect approximately 4 cm in diameter, non-painful and reducible. Patient was diagnosed clinically as direct right inguinal hernia and ultrasound confirmed the diagnosis with the presence of the appendix in the sac. A pre-operative diagnosis of right inguinal hernia was made and was planned for hernia mesh repair, during surgery under spinal blockage, the hernia sac was found to contain an appendix without signs of inflammation, so we decided to close the defect and repair with a Lichtenstein mesh hernioplasty without doing an appendectomy. In this case we treated a rare clinical entity called Amyand's hernia. This case highlights the importance of considering Amyand's hernia in the differential diagnosis of inguinal pathologies and the role of imaging modalities in pre-operative diagnosis. Various classification systems have been proposed, including those by Losanoff and Bason, later modified by Rikki et al offering insights into surgical management strategies based on the condition of the appendix and concomitant pathologies. Despite efforts to standardize treatment approaches, consensus on the optimal management strategy remains elusive, necessitating further research to refine diagnostic and therapeutic guidelines.</p> Jorge Silva-Zamora, Arturo Romero Macias, Luis A. Baigts Arriola, Cristian A. Dámazo Escobedo, Adriana G. Vizcarra Rendón, Jose G. Sevilla Flores Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Unusual finding during laparoscopic cholecystectomy: liver choristoma in the gallbladder wall <p>Hepatic choristomas or ectopic livers are rare developmental anomalies and are usually located in the abdomen, retroperitoneum and thorax. A 34-year-old male patient underwent a scheduled laparoscopic cholecystectomy, the findings during surgery were a gallbladder with multiple lithiasis inside, with a smooth fragment of reddish-brown tissue attached to the anterolateral surface of the gallbladder. The patient evolved satisfactorily and was discharged 24 hours after surgery. Objective was to describe a clinical case of hepatic choristoma adhered to the anterolateral wall of the gallbladder, as well as its etiology, clinical picture and therapeutic conduct. Hepatic choristoma in the gallbladder is due to an anomaly in the embryologic development of the liver, due to its potential for malignant degeneration, it should be resected as soon as it is detected, being laparoscopic cholecystectomy an adequate approach.</p> Miguel Ángel Echeverry-Gutiérrez, Karla Paola Muñoz Mata, Jose Manuel Zavala-Perez, Saul Ernesto Reyes-Gonzalez, Marco Antonio Trejo-Gonzalez Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Sporotrichoid cutaneous leishmaniasis: atypical form <p>Leishmaniasis comprises a heterogeneous and extensive group of infectious and non-contagious diseases caused by protozoa of the genus <em>Leishmania</em> spp. It is a disease considered endemic in 92 countries, with at least 1 million new cases of integumentary forms annually. Cutaneous leishmaniasis is endemic in the tropics and neotropics. It is often referred to as a group of diseases because of the varied spectrum of clinical manifestations, which range from small cutaneous nodules to gross mucosal tissue destruction. Cutaneous leishmaniasis can be caused by several <em>Leishmania </em>spp. and is transmitted to human beings and animals by sandflies. Despite its increasing worldwide incidence, because it is rarely fatal, cutaneous leishmaniasis has become one of the so-called neglected diseases, In endemic countries, diagnosis is often made clinically and, if possible, by microscopic examination of lesion biopsy smears to visually confirm leishmania parasites as the cause. Cutaneous leishmaniasis often presents as an ulcerated lesion, with raised, infiltrated edges, classically described as frame-like edges at the site of the mosquito bite. We report an uncommon case of a patient who presented with a lesion on the face, sporotrichoid in appearance, and thigh, which appeared simultaneously, of clinical lesions of cutaneous leishmaniasis, laboratory-confirmed and which showed excellent clinical evolution with the use of liposomal amphotericin B.</p> Walter Belda, Paulo A. Vale, Caroline H. C. Carvalho Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Gastric outlet obstruction secondary to adult hypertrophic pyloric stenosis: case report and literature review <p>Adult hypertrophic pyloric stenosis is a rare entity; the most common type is secondary to underlying gastrointestinal pathologies, such as peptic ulcer, malignant tumors, and certain inflammatory diseases. A rare case of hypertrophic pyloric stenosis is presented in an adult patient secondary to acid peptic disease, presenting with gastric outlet obstruction, treated in the first instance with pyloric dilation successfully, however, the clinical picture has recurred now with 90% hypertrophic pyloric stenosis, it was decided to perform a surgical procedure with roux-en-Y gastrojejunal diversion, progressing with adequate evolution. There is no consensus on which is the most effective treatment. However, most authors seem to favor gastric resection due to the risk of malignancy secondary to long-standing hypertrophic pyloric stenosis.</p> Citlali Calderón, Steve Belmont Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Esophageal diverticulum: a case report <p class="abstract" style="margin-bottom: .0001pt;"><span lang="EN-US">Esophagic diverticulum’s are a rare entity. The prevalence in the world population is reported to be less than 1%. They are generally diagnosed incidentally, have a higher peak of prevalence in the fifth decade of life, affecting men and women equally. The most common esophageal diverticula are epiphrenic and the main symptom is usually dysphagia. A case of a 74-year-old female with diagnosis of epiphrenic esophageal diverticulum is reported, which is treated with conservative management. The objective of this study was to describe a clinical case of esophageal diverticulum, as well as its etiology, clinical presentation, and therapeutic conduct. The screening of these patients must be focused on what the literature indicates, symptomatic patients with long-term evolution, the treatment will be surgical and with minimally invasive techniques so clinical evolution will be more favorable, reducing possible complications. </span></p> Olga E. Amador, Gabriel Gutierrez, Miguel A. Echeverry, Francisco Ayón, Jessica Esmeralda Miguel Sánchez, Cruz Alberto Tirado, Faustino Rubio Soto, Arturo Ramos Ruelas Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Zollinger-Ellison syndrome: case report and topic review <p>Zollinger-Ellison syndrome (ZES) is characterized by gastrin-secreting neuroendocrine tumors (gastrinomas) in the duodenum or pancreas. It is a rare condition, most patients are diagnosed between the ages of 20 and 50, and a higher incidence in men. Gastrinomas are associated with a high risk of malignancy and the diagnosis is confirmed by the secretin stimulation test and imaging studies such as octreotide scintigraphy. We present the case of a 24-year-old man who presented with melena, asthenia, adynamia and abdominal pain, in addition to a history of peptic ulcer. Laboratory tests revealed low levels of hemoglobin and elevated levels of gastrin. Endoscopy showed a giant ulcer and subsequent surgery revealed stomach-jejunum adhesions, gastric lesions and Meckel's diverticulum. Imaging studies confirmed neuroendocrine tumor activity in the pancreas. ZES leads to sustained hypergastrinemia, causing peptic ulcers and other digestive tract complications. Gastrinomas can arise from a variety of locations and can cause peptic ulcers, malabsorption, and diarrhea. Diagnosis requires elevated fasting serum gastrin levels and hypersecretion of gastric acid. Treatment involves discontinuation of proton pump inhibitors (PPIs) before diagnostic testing and surgical resection of tumors in suitable candidates. The diagnosis of ZES can be complicated due to the unreliability of the assays and the need for secretin testing. Surgical resection is recommended for sporadic gastrinomas without metastasis, while medical treatment may be necessary for postsurgical residual hyperacidity. Patients should undergo imaging studies for tumor localization and regular monitoring for complications and recurrences.</p> Rosaura J. Serrano, Kevin Avilés, Yanetzy E. Corona, Gaby A. Alarcón Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 A case of abdominal tuberculosis presenting as obstructive jaundice <p class="Default" style="text-align: justify;"><span style="font-size: 10.0pt;">Extrapulmonary tuberculosis is notorious for its many manifestations, which can lead to delayed diagnosis and treatment. In particular, abdominal tuberculosis is easily overlooked because the incidence is low and because it can mimic common non-infectious abdominal syndromes. We describe here a 45-year-old female presenting with obstructive jaundice. In this patient, a pancreatic mass was found and tuberculosis was first diagnosed after a diagnostic laparoscopic. Tuberculosis should be included in the differential diagnosis of intra-abdominal mass lesions, especially in persons originating from regions where tuberculosis is endemic. Invasive procedures are often required to obtain adequate diagnostic samples. </span></p> Suresh Naik, Bahar Kulkarni, Siddhant Shrotriya, Kirankumar B. Ghade Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Mycosis fungoides: a rare case report <p>Lymphoproliferative disease has many sub-types but the most-commonest subtype of cutaneous T-cell lymphoma is mycosis fungoides (MF). When it presents as solitary or oligo-lesional lesion, radiation therapy is considered potentially curative. This paper presents a case of 17-year-old female who developed two skin lesions in her left knee. She was diagnosed as a case of MF in patch stage. Localised radiation therapy was given to the lesion. MF prognosis depends overall on its stage and is usually better in the early stages. MF is rare and often requires a clinical-pathological correlation for its diagnosis, which is often delayed, especially in the early forms.</p> Ruby Panmei, Angom Ronibala Devi, Mohan Babu B., Yumkhaibam Sobita Devi Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Cracking of enigma of Evans: a rare association with Sjogren and systemic lupus erythematosus <p>Evans syndrome (ES) is characterized by the simultaneous or consecutive occurrence of warm autoimmune hemolytic anemia (AIHA) along with immune thrombocytopenia (ITP), and less commonly, autoimmune neutropenia. It may manifest spontaneously or as a result of autoimmune, malignancy or lymphoproliferative disease. Clinical manifestations may be associated with hemolysis and thrombocytopenia, potentially leading to life-threatening outcomes. ES is a rare diagnosis of exclusion. Due to its infrequency, the treatment is typically empirical, relying largely on intravenous corticosteroids or immunoglobulins. We are presenting case of a 46-year-old- female with bleeding from the mouth and gums and rashes all over the body with no prior diagnosis of rheumatological disorder. This case is pivotal as it highlights a key factor contributing to ES and presents a pragmatic method for addressing the condition.</p> Gyan Prakash Kumar, H. M. Faizul Bari, Piyush Ratan, Tanya Mishra, Ashutosh Kumar, P. N. Jha, Ashok Kumar Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Disseminated strongyloidiasis in patients on immuno-suppressive therapy <p>Strongyloidiasis is a disease that causes significant morbidity and rarely mortality in immunocompromised patients. We report two cases of disseminated strongyloidiasis infection while on steroids. The first patient was a known diabetic, hypertensive, and coronary artery disease who began on steroids with hemodialysis for biopsy-proven rapidly progressive glomerulo nephritis (RPGN). He presented to the emergency department (ED) with fever, loose stools, worsening dyspnea on exertion, cough, conjunctival congestion, and bilateral lower limb pain of 1-week duration while on hemodialysis (HD). He was started on intravenous (IV) antibiotics, suspecting a catheter-related septicemia. Stool and sputum examination revealed strongyloid infection. The patient was treated with Albendazole, Ivermectin, empirical antibiotics, and tapering and stopping of steroids. Symptoms improved and the patient was discharged in stable condition. The second case is a known case of systemic hypertension and biopsy-proven IgAN on maintenance steroids, with recently detected diabetes mellitus. He presented to the ED with tiredness, fever, cough, dyspnea, and occasional hemoptysis of 1-week duration. On evaluation, he had maculopapular rash over the chest and abdomen, along with hypoxia requiring oxygen support, thrombocytopenia, and worsening renal function. He was initially started on IV antibiotics, suspecting a lower respiratory tract infection with sepsis. Bronchoalveolar lavage (BAL) cytology yielded strogyloid larvae. The patient received ivermectin along with empirical IV antibiotics and supportive treatment but succumbed to the infection. These case reports signify the need for an active search for opportunistic infections in patients who are on continuous immunosuppressive therapy.</p> Insaf Kodiyerithodi, Shamsudeen Moideen, Benil Hafeeq, Jyothish Chalil Gopinathan, Bhagyanath T. Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 A rare nexus: G6PD deficiency's uncommon affiliation with rapidly progressive renal failure through the prism of pigment nephropathy <p>Acute kidney injury (AKI) with evidence of hemolysis is associated with tropical infections. However, pigment-induced AKI can happen with relatively uncommon genetic causes of hemolytic anemia, i.e., glucose 6-phosphate deficiency (G6PD). We share our experience of one such patients whose clinical presentation was rapidly progressive glomerulonephritis. On evaluation, she had a history of usage of some drugs and with G6PD estimation revealing deficient status even during the episode while other tests such as Coomb's test and bone marrow biopsy was normal. The kidney biopsy revealed diffuse tubular injury with presence of several coarse granular/pigmented casts in tubular lamina. She was managed with hemodialysis and showed complete recovery. Thus, in tropical countries G6PD deficiency although is not common, should be considered among patients who presented as rapidly progressive renal failure (RPRF) and having history of precipitating factors for G6PD deficiency and a detailed hemolytic work-up needs to be carried out as an important cause of preventable recurrent AKI in tropical countries.</p> Ayush Thakur, Vandana Admane, Pankaj Jawandhiya, Shital Bahekar, Akshay Jaiswal Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 A rare cause of epididymo-orchitis <p>Epididymo-orchitis is an inflammatory lesion of the testis and epididymis with a lymphocytic exudate. Patients with acute epididymo-orchitis typically present with scrotal pain, swelling, tenderness and fever. Here, we present a patient with scrotal pain and hemiscrotal swelling as the main complaints; however further investigations revealed a completely different and rare diagnosis. Zinner’s syndrome is a very rare developmental anomaly of the Wolffian duct. To date, only about 200 cases have been diagnosed. It is a triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ejaculatory duct obstruction. Some patients remain asymptomatic and discovered incidentally, while others present with symptoms related to seminal vesicle cysts or ejaculatory duct obstruction: voiding or ejaculatory difficulty or pain. Treatment options include transurethral or transrectal aspiration and percutaneous drainage, however both are linked to an increased risk of recurrence. Symptomatic, complicated and recurrent cyst will require excision of the cyst, either laparoscopically or robotically.</p> Siddanagouda B. Patil, Basavesh S. Patil, Santosh R. Patil, Vinay S. Kundargi, Nawaz A. Shariff Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Mature cystic teratoma of anterior mediastinum: a case report <p>Mediatinal mature cystic teratoma is a rare type of extra gonadal teratoma, comprising 1-5% of all mediastinal tumors. Its atypical presentation can sometimes lead to misdiagnosis, highlighting the importance of careful evaluation and intervention. We report a case of a 57-year-old male patient presenting with the complaints of chest pain and dyspnea on exertion associated with cough since 2-3 months prior to admission. Chest x ray showed a well-defined opacity in the right hemithorax. Patient underwent mass excision by median sternotomy approach. Histopathology confirmed the diagnosis of mature cystic teratoma. While anterior mediastinal teratomas are uncommon, complete surgical excision is often the primary and effective treatment. In many cases, successful removal without complications can lead to cure.</p> C. L. Anusha, P. S. S. Gopal Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Surgical techniques in bariatric surgery: minimally invasive approaches and long-term outcomes <p>Obesity is a worldwide epidemic, and current weight loss strategies frequently do not effectively tackle the problem. Bariatric surgery effectively addresses this issue. A systematic research study was done to investigate minimally invasive bariatric operations, using 32 studies from a pool of 2,118 data. Bariatric surgery was found to greatly assist in weight reduction and enhance general health results. Procedures such as gastric balloon, gastric banding, and gastric bypass can decrease the weight of obese people and alleviate associated health conditions. Sleeve gastrectomy is highly successful and yields favorable long-term results. The procedure used relies on the patient's health and the surgeon's discretion. The primary risk factor is the recurrence of weight or the need for revision surgery. Ultimately, bariatric procedures provide weight loss and long-term health benefits, but it is important to acknowledge the associated surgical risks. Immediate dangers include of blood clotting, intestine blockage, bleeding, infections, abdominal pain, nausea, heartburn, vomiting, ulcers, and other issues associated with surgery. Long-term consequences include of dumping syndrome, starvation, and weight regain.</p> <p><strong> </strong></p> Miguel Andrés Irua Veloz, Leslie Dayanna Rivera Pinto, Juan Carlos Navarrete Pérez, Andrea Gabriela Parada Marín, Henry Paúl Velasco Molina, Jean Pierre Villafuerte Copyright (c) 2024 International Journal of Research in Medical Sciences Sat, 16 Mar 2024 00:00:00 +0530 Factors associated with clinical competency of nursing students <p>A critical priority and challenge in nursing education today is caused by the variability of the healthcare environment. This systematic review reported findings on the independent variables that are associated with nursing students' clinical competency. A literature review search was conducted using Mendeley’s website in 2023 with using keywords such as nursing clinical competency and nursing student. The Mixed Methods Appraisal Tool (MMAT) was used to appraise and describe the methodological quality. A narrative report was given on the synthesis of the results. Based on the inclusion and exclusion criteria, 16 papers were retained out of 1162 identified research publications. Among 16 papers, the common predictive factors mentioned in the reviewed articles on the clinical competency of nursing students include clinical learning environment, self-efficacy, and self-awareness. Other factors such as clinical training program, type of learning-teaching, learning experiences, and socio-demographics were involved as the significant variables toward clinical competency. There are several other characteristics or predictors of clinical competency that require further investigation.</p> Bonsak Yoeum, Virya Koy, Rany Sam Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Dental fluorosis: a review <p>Ingesting fluoride for prolonged periods or in doses higher than those recommended during enamel formation produces changes from the appearance of very thin white lines to serious structural defects, resulting in a pathological entity known as dental fluorosis. The severity of the changes depends on the amount of fluoride ingested; it is a disease that has an epidemiological behavior with endemic characteristics. The indicated management for TF1 and TF2 lesions is dental whitening or infiltrating resin; for TF3 and TF4 micro abrasion and/or whitening and in TF5 combined technique with macro, micro abrasion and dental whitening. It is essential that public health actions be prioritized to mitigate potential complications due to fluorosis, especially in areas identified as endemic.</p> Fernando Rosas López Portillo, Victor Manuel Rosas Alcaraz, Jesús Gámez Valenzuela, Ingryd Fabiola Molina Ángulo, Martha Viridiana Gonzáles Jiménez, Anel Karely Olivas Velázquez, Cinthia Lizbeth Reyna Solis, Adelina Rocha López, José Aurelio Cortina Aguilar, Juan José Villalobos Rodelo, Cristhal Duque-Urióstegui Copyright (c) 2024 International Journal of Research in Medical Sciences Wed, 06 Mar 2024 00:00:00 +0530 Significance of calcium: its correlation with red and white muscle contraction, fatigue and potential <p>According to the predominant types of muscle fibers in an individual, they will have the ability to perform different types of exercises (both aerobic and anaerobic). To comprehend the mechanism of muscle fibers, which can act in diverse ways, enhancing either resistance or power, it is essential to examine the significance of calcium. Calcium plays a crucial role in both red and white muscle fibers. The release of calcium in white (fast-twitch) muscle fibers is significantly greater and faster, resulting in increased energy consumption, facilitating explosive physical activities. Conversely, in red (slow-twitch) muscle fibers, the release of calcium occurs in smaller amounts and over a prolonged period, leading to sustained energy consumption. The characteristics of contraction in red fibers enable endurance activities. A reduction in the amount of calcium results in diminished muscle contractile capacity, known as fatigue. The primary contributing factor, as previously mentioned, is the decline in calcium, but factors such as lactic acid and the dephosphorylation of the myosin head also contribute to its onset.</p> Alejandra A. Castro, Mariano B. L. Perez, Guillermo A. Gonzalez, Natalia C. Bonilla, Gerardo G. Santiago, Ishmeet Singh Copyright (c) 2024 International Journal of Research in Medical Sciences Thu, 21 Mar 2024 00:00:00 +0530 Artificial intelligence and mental health: a review article <p>The term AI was originally coined by a computer scientist, John McCarthy, who defined it as the science and engineering of making intelligent machines. The father of AI authored a 1950 article, “Computing Machinery and intelligence” that discussed the reasons for considering a machine to be intelligent. Artificial intelligence is useful to facilitate faster disease detection. It helps to understand disease progression, improve medication/treatment dosages, and discover innovative treatments. The artificial intelligence tools mostly used for psychosis risk screening are chatbots and large-scale social media data analysis. Chatbot is a computer program that allows human-computer interactions in the form of textual dialogue based on the technology of natural language processing. The world's first chatbot, ELIZA, was designed in the 1960s and responds to special rules by recognizing keywords in user-entered text. Chatbots in the mental healthcare field include Tess, Florence, Buoy Health, and Your. Md. In addition to natural language processing, the machine learning methods adopted by chatbots also include natural language understanding, artificial neural networks, and recurrent neural networks.</p> Debajani Deka Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Exploring the viability of newer technologies in care and management of tribal diabetes and metabolic syndrome in India <p>With the advancements of digitalization technology in health sector, diabetes care and management have also experienced modifications and betterment. Various newer technologies cater to the individual conditions and needs and provide a personalized treatment. Device based technologies such as continuous glucose monitoring (CGM) linked to closed loop insulin delivery system, insulin pumps, wearable devices linked with mobile apps have made the self-management of diabetes possible on regular basis. In its contrast, the technologies are yet to reach the tribal settings of India, and also very challenging to implement. Studies have shown that the scenario of diabetes prevalence in Indian tribal population is as crucial as urban population. Also, land alienation, lack of health management infrastructure, low connectivity, technological challenges add up to their condition. While various technologies are challenging to implement due to electricity, network connectivity, infrastructure and storage facilities, some technologies can be implemented easily with the joint approach of primary health care staff, governmental and non-governmental organizations and people with diabetes themselves. Digitization of data is needed as it will give a clearer picture of the prevalence, provide easy access for the follow ups and easier to implement intervention-based technologies. The situation demands a tailored multifaceted approach for implementing the technological based remedies in tribal settings of India as it will increase the quality of life in these areas.</p> Kritika Singh, Tapas Chakma, Suman Ray, Neha Vaidh, Suyesh Shrivastava Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Bacterial vaginosis and the role of prebiotics and probiotics: current practices <p>Bacterial vaginosis (BV) is characterized by overgrowth of opportunistic bacteria and a decrease in the levels of <em>Lactobacilli</em>. BV is commonly encountered by gynaecologists practicing in India. The opinions of 21 gynaecologists across India regarding diagnosis and management of BV were sought via focussed group discussions. In Indian women, BV is more common in the reproductive age group, perimenopausal women, women with polycystic ovarian disease (PCOD), pregnant women, and in teenagers/pubertal age group. BV is often underestimated as it is not diagnosed by family physicians. The panel of experts opined that they preferred to conduct screening for BV in all high-risk pregnant cases, women with bad obstetric history such as premature abortions and women with a history of tuberculosis. One challenge faced by clinicians in the real-world setting is recurrent infections of BV in their patients. For the treatment of BV, antibiotics can be prescribed along with pre-probiotics to avoid dysbiosis and to prevent recurrence of BV. Pre-probiotics should be administered in sufficient amounts for adequate management of BV. More than 80% of <em>Lactobacilli</em> species should be present in an ideal pre-probiotic to ensure adequate production of acid and bacteriocins for the destruction of unhealthy bacteria and prevention of microfilm formation. The results with the pre-probiotics used will depend on the quality of the formulation and the maintenance of the cold chain. Prebiotic -probiotic supplementation may be considered a new adjuvant treatment for BV.</p> Mukesh Gupta, Brajbala Tiwari Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Drug repositioning: current scenario and future prospective for rewriting saga of drug development <p>Drug development is a process that demands huge investment of resources and time with only 1 drug candidate successful in reaching market among 10,000 screened taking time duration of 10-15 years and millions of dollars. This high attrition rates discourage investors and researchers. The pharmaceutical industry is shifting its attention away from <em>de novo</em> drug research and towards discovering novel targets and indications for already-approved drugs. In order to accelerate the drug development process with reduced risk of failure and relatively lower costs, pharmaceutical companies have adopted drug repositioning as an alternative. Therefore, a good strategy for drug development would be drug repositioning or drug repurposing, which is to identify, investigate, and exploit new therapeutic uses of already-available, on-market drugs, as well as those that have been withdrawn due to toxicities or that remain on shelves in various stages of development. The outbreak of SARS-COV-19 shows that humanity is constantly vulnerable to epidemics and new microbial attacks and that there is no time to create disease-specific therapies. Consequently, it would seem advantageous to use what is already accessible. Novel therapeutic indications that have previously been approved by the market can reduce investment costs significantly in terms of money, resources, and most importantly, time, as long as they meet PKPD and toxicity standards. Sponsors and pharmaceutical corporations get enthusiastic about additional investments and initiatives related to drug development as a consequence. The upcoming therapeutic revolution, especially with the aid of artificial intelligence, is indicated by the successful applications of several already-available drugs against COVID-19 and the various phases of repurposed drugs against TB, colorectal cancer, Alzheimer’s disease, cervical cancer, and Parkinsonism.</p> Alok Dixit, Ajit K. Mishra, Chandra Veer Singh, Vinay Kumar Gupta, Devesh Pandey Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Dental crowding: a review <p>Dental crowding is a frequent characteristic of dental malocclusion and is the reduction in the perimeter of the arch that can manifest as space closure, rotation and/or movement of the teeth. The temporary dentition is important as it guides the eruption of the permanent teeth, thus establishing the ideal occlusion; the lack of spaces can cause disproportionate sizes between the jaws and the permanent teeth. Treatment options include the orthopedic phase and orthodontic phase in which the extraction of teeth may or may not be necessary. Timely treatment with personalized planning helps us achieve correct dental occlusion, which is essential for good chewing and correct passage of the bolus, in addition to playing an important role for phonation and the aesthetic results for the patient.</p> <p><strong> </strong></p> Fernando Rosas López Portillo, Jesús Gámez Valenzuela, Victor Manuel Rosas Alcaraz, Aurea Elizabeth Valle Urias, Daniela Del Rosario Martínez Pérez, Félix Manuel Manjarrez Guerrero, Gloria Elena Guzmán Celaya, Tonantzin González Arredondo, Marco Antonio Quiroz Beltrán, Martha Lilia Soberanes Galindo, Cristhal Duque-Urióstegui Copyright (c) 2024 International Journal of Research in Medical Sciences Wed, 06 Mar 2024 00:00:00 +0530 Benefits of core strengthening exercise in osteoarthritis knee patients: a narrative review <p class="abstract" style="margin-bottom: .0001pt;">Osteoarthritis is a degenerative joint disease results from breakdown of cartilage that covers the ends of bones in joint. Breakdown causes bones to rub each other leading to pain, stiffness, swelling, loss of function in joint and can be accompanied by synovitis with or without joint fluid effusion. Muscle atrophy may develop if patient was inactive and did not perform exercises, which will affect functionality and stability of joint including activities of daily life. The aim of the study was to evaluate current literature and provide comprehensive overview of benefits of core muscle strengthening exercise in managing OA. The objective of this study was to discuss effectiveness of core muscle strengthening exercise in reducing pain, improving physical function, and enhancing quality of life in individuals with osteoarthritis knee. A systematic search was conducted to identify all relevant studies related to core muscle strengthening, database such as Pubmed, Cochrane library, Scopus had been used. Studies demonstrating clinical importance of core strengthening in treatment of osteoarthritis knee are limited. By performing randomized controlled trials with a big sample size, new researchers should produce more unique findings.</p> Aavrati Rastogi, Roop B. Kalia, Pradeep K. Meena Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Immunology of vernal keratoconjunctivitis <p class="abstract" style="margin-bottom: .0001pt;">Vernal keratoconjunctivitis (VKC) is a bilateral seasonally occurring chronic inflammation of the conjunctiva especially in the adolescent boys, the pathogenesis of which includes a variety of genetic, climatic and environmental factors. The symptoms include itching, photophobia, watering and redness, ropy discharge which eventually lead to punctate epithelial erosions, shield ulcers over corneal and affects the vision and quality of life of young children. There are three types of VKC- palpebral, bulbar and mixed forms. The palpebral form has cobble stone papillae and congestion. The bulbar form shows horner tranta spots and pseudogerontoxon, while the mixed form has both. Several cells like histamines, IgE, chemokines, lymphokines play a role in the pathogenesis of the disease. The aim of this review was to review article of the multitude of cells and mediators that have a relevant role in VKC and the necessary treatment options targeted against the specific cells that may help in subsiding the disease process.</p> <p> </p> <p> </p> Gompa Mohana Preethi, Puja Rai Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Roots and fates of congenital insensitivity to pain and anhidrosis: a human phenotype <p>Congenital insensitivity to pain is a rare neurological disorder characterized by the inability to perceive physical pain. Individuals with CIP lack the typical nociceptive responses to harmful stimuli, which poses significant challenges to their safety and well-being. This condition is often caused by genetic mutations affecting the nervous system's ability to transmit pain signals. Despite the apparent advantage of not experiencing pain, CIP presents severe risks as affected individuals may unknowingly sustain injuries or develop medical complications without timely intervention. The absence of pain perception hinders the learning of protective behaviour and responses to potentially harmful situations, making daily activities fraught with danger. Understanding the genetic basis of CIP has provided valuable insights into pain perception and the functioning of nociceptive pathways. While this knowledge may pave the way for potential therapeutic interventions, managing CIP remains a complex task. This article provides an overview of CIPA, its genetic basis, clinical manifestations, complications, treatment and the challenges associated with managing this complex condition. A multidisciplinary approach involving genetic counselling, pain management, and specialized care is crucial to support individuals with CIPA and improve their overall well-being.</p> <p> </p> <p> </p> Rosheni R. K., Surabhi K. S., Fiza S. H., Thanushree D. R., Robin George Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Clinical spectrum and treatment outcomes in variants of Guillain-Barré syndrome: a case series <p>Guillain-Barré syndrome (GBS) is an autoimmune polyradiculoneuropathy that is acute, typically severe, and fulminant. GBS has an incidence of 0.81-1.89 (median 1.11) per 100,000 person-years, and men are slightly more susceptible to GBS than females. 70% of individuals acquire this acute flaccid paralysis condition within 1-4 weeks following a respiratory infection or diarrhoea (especially <em>Campylobacter jejuni</em>). There are several identified subtypes of GBS, with acute inflammatory demyelinating polyneuropathy (AIDP) being the most prevalent. Additionally, there are two "axonal" subtypes: acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN), both of which are clinically severe. The clinical trial of ophthalmoplegia, ataxia, and areflexia characterizes a different subtype called Miller Fisher syndrome (MFS) linked to anti-GQ1b antibodies. The patient's medical history, along with neurological, electrophysiological, and cerebrospinal fluid tests, are used to diagnose GBS. Intravenous immunoglobulin (IVIG) and plasma exchange are effective treatments; however, newer approaches are required because 25% of patients eventually need mechanical ventilation, 20% are unable to walk, and 2-5% of patients may experience relapses.</p> Yashfeen M., Mugundhan K. Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Combination therapy in the treatment of Stevens-Johnson syndrome/toxic epidermal necrolysis: a case series and review of literature <p>Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening disease of skin and mucous membrane that are mostly caused by drugs. Many studies have focussed on treatment that modify immunologic responses like corticosteroid, IVIG, cyclosporine, biologics like TNF-α inhibitors etanercept, infliximab etc. But there are few studies available on using two immunomodifier drugs simultaneously. However, no standardized treatment protocol has been established for SJS/TEN patients. We present a case-series of 10 SJS-TEN patients treated with both systemic corticosteroid and cyclosporine. We provide a review of literature on individual systemic corticosteroid, cyclosporine and also simultaneous use of both agents for SJS/TEN, including various outcome measures-stabilization, mortality rate, hospital length of stay and comparison to other systemic agents.</p> Soumi Biswas, Arun Achar, Chinmay Bera, Adityendu Chakraborty, Mahasweta Ghosh, Monika Kumari Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Qatar National Diabetes Strategy for the growing diabetes pandemic (2016-2022) - are we there yet? <p>Diabetes Mellitus (DM) is increasingly recognized as a major public health challenge with 422 million people suffering worldwide in 2014. Awad et al anticipated that by 2050, that DM prevalence and incidence in Qatar will rise significantly, emphasizing the rapidly expanding need for health care resources to treat the condition and highlighting the necessity of intervention techniques for treatment and prevention that are specific for each nationality in Qatar.</p> Benazir Shah Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Screening the risk factors of type 2 diabetes mellitus in minor ethnic Bishnupriya Manipuri community in Bangladesh <p><strong>Background:</strong> Type 2 diabetes mellitus (T2DM) development involves various interrelated risk factors, including age, gender, obesity, and inactivity. However, research lacks insights into the risk factors within the minor ethnic Bishnupriya Manipuri community in Bangladesh. This study aimed to identify T2DM risk factors within this community.</p> <p><strong>Methods:</strong> This survey-based prospective observational study was conducted in different villages of Kamalgonj Upazila under the Moulvibazar district in Bangladesh from March 2023 to June 2023 enrolled 280 individuals using purposive sampling. Data collection involved a questionnaire, verbal agreement, and diagnostic documentation. Analysis utilized Microsoft Office and the student’s t-test.</p> <p><strong>Results:</strong> Participants exhibited a 1:1.2 male-female ratio, with 64% aged 36-65. 43% were housewives, 55% engaged in moderate work, 15% smoked, and 41% had a family history of diabetes. Diabetic cases accounted for 39%, with an average age of 57.39±11.99 years, significantly higher than non-diabetic cases (46.79±17.93 years). Diabetic cases also showed significantly higher waist circumference (94.11±6.63 cm versus 84.71±14.76 cm) and body mass index (BMI) (26.12±7.61 kg/m<sup>2</sup> versus 21.44±6.97 kg/m<sup>2</sup>).</p> <p><strong>Conclusions:</strong> T2DM predominantly affects older individuals in the Bishnupriya Manipuri community. Increased waist circumference, overweight, and obesity emerged as significant risk factors for T2DM within this population.</p> Swapan K. Singha, M. Shah Emran, Sharadindu K. Sinha, Sunia Sinha, Kamal U. Ahmed, Dihan Tahite Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Efficacy of rifaximin among non-constipated irritable bowel syndrome patients with or without small intestinal bacterial overgrowth: a randomized, double-blind, placebo-controlled trial <p><strong>Background:</strong> IBS is a functional gastrointestinal disorder marked by abdominal pain and changes in stool frequency or form. Recent studies indicate a link between IBS, especially the diarrhea-predominant subtype, and small intestinal bacterial overgrowth. This study aimed to evaluate symptom resolution among IBS patients with or without SIBO on rifaximin treatment as compared with placebo.</p> <p><strong>Methods:</strong> A double-blind, placebo-controlled, randomized clinical trial took place at the Department of Gastroenterology, Dhaka Medical College and Hospital, from January to December 2019. In the study 104 non-constipated IBS patients were assessed for SIBO using gut aspirate culture. Those with SIBO (≥105 CFU/ml) and those without were randomly assigned (computer-generated) to receive either 1500 mg/day of rifaximin for 14 days or a placebo.</p> <p><strong>Results: </strong>Among 104 non-constipated IBS patients, 39% had SIBO, with IBS-D patients more associated (83% vs. 60%). Rifaximin significantly improved symptoms in the SIBO group at 4 and 16 weeks (90% vs. 20%, p&lt;0.001; 66% vs. 15%, p&lt;0.001). In the non-SIBO group, significant improvement was observed at 4 weeks (38.7% vs. 18.8%, p&lt;0.001) but not at 16 weeks (25.8% vs. 18.8%, p=0.501). Rifaximin significantly improved abdominal pain, stool form, and frequency in the SIBO group compared to placebo. However, there was no significant improvement in the non-SIBO group.</p> <p><strong>Conclusions:</strong> Rifaximin is superior to placebo in relieving symptoms of non-constipated IBS patients with SIBO.</p> Subrata Podder, M. Masudur Rahman, Mohammad Iqbal Hossain, Raj Datta, Jane Alam, M. Golam Kibria Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Characteristics of intracranial atherosclerosis disease in stroke cases in Indonesia utilizing cerebral digital subtraction angiography <p><strong>Background: </strong>Intracranial atherosclerosis disease is a cause of ischemic stroke. Risk factors of ICAD included age, gender, race/ethnicity, hypertension, diabetes mellitus, and dyslipidaemia. This study aimed to describe the profile of ICAD in first-ever stroke and its association of recurrent stroke.</p> <p><strong>Methods: </strong>The was a prospective cohort study conducted at a private hospital in Indonesia between January 2021 and June 2022. Inclusion criteria included patients with first-ever stroke and intracranial stenosis confirmed through digital subtraction angiography. The incidence of recurrent stroke was observed at six-month follow-up.</p> <p><strong>Results: </strong>Of 40 subjects, 25 (62.5%) were females and most ages ranged from 20 to 40 years old. The prevalent site of intracranial stenosis were internal carotid artery in 19 (23.2%) and anterior cerebral artery in 19 (23.2%) subjects. Following six-month follow-up, there was only a patient with recurrent stroke.</p> <p><strong>Conclusions:</strong> In first-ever stroke in Indonesia, ICAD was predominantly described in younger men within 41-60 years old. Stroke recurrence was observed in a patient who was old and had multiple comorbid. Further studies using a larger area and longer duration of follow-up may be considered to provide a more generalized description of ICAD in Indonesia.</p> Fritz S. Usman, Merlin P. Kastilong, David Susanto, Muhammad Welly Dafif, Gomgom Henrico Sirait Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Patterns of aldosterone, renin level and aldosterone/renin ratio in young hypertensive patients <p><strong>Background:</strong> Hypertension is a common disease that affects a vast and diverse patient group. Aldosterone, the primary human mineralocorticoid, is increasingly recognized as playing a key role in cardiovascular morbidity, and its involvement in hypertension has lately been evaluated by studies. It is estimated that it accounts for up to 13% of all hypertension patients and 20% of resistant hypertension cases. This study aimed to observe the patterns of aldosterone, renin level, and aldosterone/ renin ratio in young hypertensive patients.</p> <p><strong>Methods:</strong> This was a retrospective observational study and was conducted in the Department of Medicine Popular Medical College Hospital, Dhaka, Bangladesh during the period from June, 2023 to December, 2023. In our study, we included 124 hypertensive patients who visited the outdoor department of medicine of our hospital.</p> <p><strong>Results:</strong> In our study, we found mean age was 33.38±4.49 years. The majority (75%) of our patients were male. The mean SBP and DBP were 136.77±17.54 and 88.58±10.72 mmHg respectively. The mean aldosterone level was 148.74±125.91 pmol/L. The mean plasma renin activity and aldosterone to renin ratio were 10.03±12.04 ng/mL/hr and 22.98±28.66 respectively.</p> <p><strong>Conclusions:</strong> In our study, we aimed to determine the pattern of ARR ratio in young hypertensive patients. We found that aldosterone renin ratio (ARR) levels play a crucial role in identifying the etiological patterns of young hypertensive patients e.g. Conn's syndrome, Liddle's syndrome, etc.</p> Sumanta Kumer Saha, Tamanna Tabassum Moni, M. Rezaul Kadir Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Observation of cardiac profile among the adult population of Sreemangal <p><strong>Background: </strong>Cardiovascular diseases are a leading cause of morbidity and mortality worldwide. The prevalence and risk factors of CVDs vary across different populations and regions. This study aimed to observe the cardiac profile among the adult population of Sreemangal, Bangladesh, to identify the prevalence and risk factors of CVDs in this population.</p> <p><strong>Methods: </strong>This prospective observational study was conducted over a six-month period at a public health camp in Sreemangal, Bangladesh. A total of 137 adult participants were purposively selected. Data were collected through a structured questionnaire and physical examination, including measurements of blood pressure and laboratory analysis of blood samples.</p> <p><strong>Results: </strong>The study found that 44.53% of participants had elevated blood pressure, and 21.90% had stage 1 hypertension. Interestingly, 36.50% of participants were unaware of their hypertension status. Furthermore, 26.28% of participants had a known history of diabetes, but blood glucose level analysis revealed an additional 14.85% of participants were prediabetic, and 6.93% were diabetic based on fasting blood glucose levels. A statistically significant association was found between increasing age and the stage of hypertension (p&lt;0.001), and between fasting and normal blood glucose levels and the stage of hypertension (p&lt;0.005 and p&lt;0.05, respectively).</p> <p><strong>Conclusions: </strong>The findings of this study underscore the need for targeted interventions to prevent and manage CVDs in the adult population of Sreemangal, Bangladesh. These interventions should include regular screening for CVD risk factors, health education to increase awareness of these risk factors, and strategies to promote healthy lifestyle behaviors.</p> M. Nazem Al Qureshee Rafat, A. H. M. Anisuzzaman, Niloy Chandra Das, Arpita Roy, Abdullah Al Mamun, M. Anwarul Amin, M. Hasan Ali, Dihan Tahite Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Outcome of perforator propeller flap for the coverage of soft tissue defects over middle and distal part of leg <p><strong>Background:</strong> Plastic surgery is a constant battle between blood supply and beauty. The end result of a reconstructive procedure is primarily attributable to the stability of the vascular component, which is fundamental in that it ensures survival and proper functioning of tissues that have been transferred to the recipient site. The aim of the study was to evaluate the clinical outcome of perforator propeller flap for coverage of soft tissue defects in middle and distal legs.</p> <p><strong>Methods:</strong> This was a prospective observational study and was conducted in the Department of Plastic Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh during the period from September 2018 to February 2020. The study population includes the total of 30 patients having soft tissue defects of the middle and distal thirds of leg necessary for flap coverage in the Department of Plastic Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh.</p> <p><strong>Results:</strong> In total 30 patients maximum 11 (36.7%) were in 31-40 years age group. Majority 27 (90%) were male and 3 (10%) were female in our study. Out of 22 flaps in distal leg necrosis occurred in 4 (18.19%) and among 8 flaps in middle leg necrosis occurred in 1 (12.5%).</p> <p><strong>Conclusions:</strong> This study observed that that perforator propeller flaps are ideal in reconstructing soft tissue defects of the middle and distal third of the leg, being safe, easy to perform, providing similar tissue in texture and thickness of damaged tissues, with low donor site morbidity.</p> M. Nazrul Hossain Mullah, M. Ruhul Amin, M. Noor-E-Alam, Istiaq Sultan, Mosabbir Ahmad Khan, Lailun Nahar, Hasan Nazir Uddin, Tanveer Ahmed Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Evaluation of current physical symptoms and psychological sufferings of patients during attending department of palliative medicine in a tertiary care hospital <p><strong>Background: </strong>Empirical evidence indicates that anxiety and depression in cancer patients are often overlooked, leading to insufficient assistance for their psychosocial needs. Distinguishing between clinical anxiety and depression and the typical emotional distress post-cancer diagnosis can be challenging but holds significant implications for coping strategies and outcomes. The aim of this study was to assess current physical symptoms and psychological sufferings of patients’ during attending in a Palliative care department of a tertiary care hospital.</p> <p><strong>Methods: </strong>This cross‐sectional study was conducted among 191 patients with cancer attending the department of palliative medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from November 2021 and March 2022. Data was collected by face‐to‐face interview using a structured questionnaire. Depression and anxiety were evaluated using a modified version of the primary care evaluation of mental disorders guide.</p> <p><strong>Results: </strong>47 participants (20.7% prevalence of depressive disorders and 13.9% prevalence of anxiety disorders) met the diagnostic criteria for at least one anxiety or depressive disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The 95% confidence interval for these results was between 20.2 and 29.0.</p> <p><strong>Conclusions:</strong> In summary, depression and anxiety disorders are prevalent among patients in palliative care, significantly reducing the quality of life for those facing cancer-related mortality.</p> Sabikun Naher Urmy, Afroja Alam, Shah Noor Sharmin, Mossa Nupur Aktar, Rahat Noor, Rakiba Sultana, M. Shaidur Rahman, Kazi Sanzida Haque Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Clinico-pathological profile of breast cancer patients in a radiation therapy centre <p><strong>Background:</strong> The aim of the study was to evaluate the clinico-pathological characteristics of patients with breast cancer at the Radiation Center of Bangabandhu Sheikh Mujib Medical University (BSMMU), a tertiary‑care cancer center in Dhaka, Bangladesh. </p> <p><strong>Methods:</strong> This descriptive study was conducted from March 2021 to February 2022 where patients receiving radiotherapy for breast cancer were included. Data were collected from face-to-face interviews with patients and from their investigation reports. Data regarding age, presenting symptoms, histological type, tumor size, involvement of regional nodes, hormonal receptor status, and human epidermal growth factor receptor 2 (HER2) amplification were recorded and then analyzed.</p> <p><strong>Results:</strong> The mean age of the patients was 52.53 years. Most of the patients (93%) were multiparous and 62.24% were postmenopausal. The most common symptom was breast lump (91.6%). Infiltrating ductal carcinoma and lobular carcinoma were seen in 136 (95.1%) and 7 (4.9%) cases respectively. The TNM stage distribution was stage I, 6 (4.2%); stage II, 52 (36.36%); stage III, 76 (53.15%); and stage IV, 9 (6.29%). Locally advanced breast cancer constituted 42.66% of the cases. Among the patients 90 (62.94%) patients were ER/PR positive and 42 (29.37%) patients were HER2 positive. Triple negative breast cancer (TNBC) constituted 25.17% (36) of the study population. All receptors were positive in 25 patients (17.48%).</p> <p><strong>Conclusions:</strong> Majority of our patients receiving breast radiotherapy at our center are middle aged and have advanced disease. TNBC and HER2 positive breast cancer are more common in our population.</p> M. Masudur Rahman, Mohammad Jahan Shams, Mostafa Sanaul Haque, Shourov Biswas Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Versatility and modifications of the cross-finger flap in reconstruction of digital soft tissue defect <p><strong>Background:</strong> Hand injuries can cause major functional and cosmetic concerns. The cross-finger flap (CFF) is an effective treatment for complex finger defects. While CFF has typically been employed to treat volar aspect abnormalities, new versions now address a larger variety of digital soft tissue defects. The aim of the study was to evaluate the clinical outcome of various modified techniques of cross-finger flap which are used to reconstruct different soft tissue defect of fingers.</p> <p><strong>Methods:</strong> This was a prospective observational study carried out in the department of Burn and Plastic Surgery at Dhaka Medical College Hospital, Dhaka from September 2018 to February 2020. Forty (40) patients who presented with different soft tissue defect of fingers included in this study according to inclusion and exclusion criteria.</p> <p><strong>Results:</strong> The study involved predominantly male participants (80%), with a mean age of 31.70±14.28 years. The most common soft tissue defect site was the volar area (47.5%), and various modified cross-finger flap techniques were employed. The majority of patients achieved excellent functional outcomes, with 82.5% classified as good, 12.5% as satisfactory, and 5.0% as poor.</p> <p><strong>Conclusions:</strong> The modifications of the cross-finger flap are versatile and useful for different sites of digital injuries with good functional outcome.</p> M. Ruhul Amin, M. Nazrul Hossain Mullah, M. Noor-E-Alam, Aleem-Al-Razee Khan, Lailun Nahar, M. Ashiqur Rahman, Shafia Nasrin, M. Salah Uddin Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Total cholesterol and triglycerides status in autistic spectrum disorder children: a case-control study on Bangladeshi children <p><strong>Background:</strong> Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by challenges in social interaction, communication, and repetitive behaviors. The association between lipid profiles, particularly total cholesterol and triglycerides, and ASD in children is a growing focus in pediatric health research. This study aimed to assess the total cholesterol and triglycerides status in autistic spectrum disorder children.</p> <p><strong>Methods:</strong> This cross-sectional study was conducted in the department of physiology, Bangabandhu Sheikh Mujib Medical University, Dhaka from March 2014 to January 2015 with 100 male children, half in a healthy control group (group A) and the other half diagnosed with autism spectrum disorder (group B).</p> <p><strong>Results:</strong> In this study, no significant correlation was found between the groups for age (p=0.94) or BMI (p=0.29). The mean (±SE) serum total cholesterol levels were 146±1.70 mg/dl in group A and 145.00±3.77 mg/dl in group B, showing no significant difference between the two groups (p=0.885). But, the mean (±SE) serum triglyceride levels were 86.14±3.28 mg/dl in group A and 107.74±7.91 mg/dl in group B, with significantly higher levels compared to group A (p&lt;0.01).</p> <p><strong>Conclusions:</strong> Although there is no significant difference in serum total cholesterol levels between healthy children and those with autistic spectrum disorder, there is a significant difference in serum triglyceride levels. Therefore, further studies are needed to provide a clearer understanding of the lipid profile comparison.</p> Shahana Parvin, Shorifa Shahzadi, Nasir U. Ahmed, Mahadi A. Rouf, Shahriar Masood Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Comparison of non-invasive scores predictive of development of metabolic dysfunction associated liver disease in patients of type 2 diabetes mellitus and evaluation of additive effect of smoking in these patients <p><strong>Background:</strong> Metabolic dysfunction associated liver disease (MASLD) has been found to be at alarming increase in Indian population. Prevalence of metabolic syndrome including Type 2 Diabetes Mellitus is also increasing which may be attributed to certain lifestyle changes. In the present study, we compared the likelihood of liver fibrosis by measurement of non-invasive scores among Type 2 diabetics and smokers, Type 2 diabetics but non-smokers and healthy controls. Our study will provide useful insights to evaluate the association between Type 2 diabetes, smoking and development of MASLD.</p> <p><strong>Methods:</strong> The study was done at a tertiary care hospital. Participants were divided into 3 groups (each of 40 participants) which included those with type 2 diabetes mellitus and smokers, those with type 2 diabetes mellitus but non-smokers and healthy controls. Parameters included in the database were age, sex, body mass index, history of diabetes, history of hypertension, any medication, tobacco use and alcohol consumption. Venous blood samples were taken in the morning after a 12-h overnight fasting and investigations were done. Results were recorded.</p> <p><strong>Results:</strong> FIB-4 score and AST/ALT ratio was significantly higher in diabetics and smoker patients, in comparison to diabetics but non-smokers and healthy controls.</p> <p><strong>Conclusions:</strong> Smoking and underlying type 2 diabetes mellitus have a synergistic effect on the severity of fibrosis, as compared to nonsmokers with type 2 diabetes mellitus. Hence smoking cessation, in addition to glycemic control with regular medication, may be beneficial in reducing the severity of MASLD among patients with type 2 diabetes mellitus.</p> Heena Singla Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 08 Mar 2024 00:00:00 +0530 A study of genital pruritus in female patients attending the dermatology OPD at a tertiary care center in South Rajasthan <p><strong>Background:</strong> Genital pruritus is a common complaint among women, the cause of which could be multitude. Identification of these causes can lead to prompt resolution of pruritus with appropriate therapies. The objective of our study was to determine the clinical profile of genital pruritus and its impact on quality of life amongst all female patients attending Dermatology OPD at our tertiary care centre.</p> <p><strong>Methods:</strong> An observational, descriptive, cross-sectional study conducted from June 2020-May 2021on 196 female patients attending the dermatology OPD with primary complaints of genital pruritus. Diagnosis was established by history and clinical examination and confirmed by bed side tests and laboratory investigations as and when required.</p> <p><strong>Results:</strong> The mean age of the patients was 36.87±15.24 years with 41.8% in the age group of 18-35 years. In majority (47.4%) of patients, itch was of moderate severity according to the Numerical rating scale. Infectious diseases (45.9%) were the most common cause followed by inflammatory (33.2%), idiopathic (19.4%) and hormonal (1.5%). Vulvovaginal candidiasis was by far the commonest (36.2%). The most common inflammatory dermatoses were lichen simplex chronicus (12.2%) followed by lichen sclerosus atrophicus (10.2%) and contact dermatitis (6.1%). 7 patients with idiopathic itch were diagnosed to have an underlying psychiatric illness.</p> <p><strong>Conclusions:</strong> As genital pruritus has multiple causes, proper categorization and diagnostic evaluation would be appropriate to achieve optimal treatment to meet the diverse needs of women who suffer from it.</p> Renjana S., Asit Mittal, Manisha Balai Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 08 Mar 2024 00:00:00 +0530 Screening of infants and young children with hyperbilirubinemia for sensorineural hearing impairment: an institutional study <p><strong>Background:</strong> Jaundice is one of the most common problems occurring in newborns. Severe neonatal hyperbilirubinemia is a common cause of sensory neural hearing loss. It is important to identify and treat the jaundice early, to prevent complications like encephalopathy leading to hearing loss. Early detection of hearing loss is important for early intervention. The aim of the study was to evaluate the prevalence of sensorineural hearing loss (SNHL) in children with hyperbilirubinemia and to correlate the degree of hearing loss with degree of hyperbilirubinemia.</p> <p><strong>Methods: </strong>The 50 cases including newborn and young children (&lt;12 years of age) having history of hyperbilirubinemia and exchange transfusion were included in this study. After the approval and clearance from institutional ethical committee, this study was conducted from April 2021 to March 2022 in the department of ENT, govt. medical college Amritsar in co-ordination with department of pediatrics.</p> <p><strong>Results</strong>: On comparing brain stem evoked response audiometry (BERA) and otoacoustic emissions (OAE) results, it was found that out of 50 patients BERA was abnormal in 8 patients while 42 had normal BERA. 18% (9) patients had abnormal OAE results out of which 7 had bilateral REFER result while 2 had unilateral REFER result. On comparing the OAE and BERA for sensitivity and specificity, the sensitivity was 92.9% in right ear while specificity was 62.5%, whereas in left ear sensitivity was 95.2% while specificity was 75%.</p> <p><strong>Conclusions: </strong>According to our study the prevalence of sensorineural hearing impairment comes out to be 16% as per BERA. BERA is more sensitive and specific as compared to OAE. But still OAE can be used as screening test considering the cost factor and ease of conducting OAE test while BERA is a confirmatory test for SNHL.</p> Rubal Banger, Arvinder Singh Maan, Ashwani Kumar, Ruchika Bhagat, Anjana Kumari Copyright (c) 2024 International Journal of Research in Medical Sciences Wed, 06 Mar 2024 00:00:00 +0530 Intestinal obstruction caused by tuberculosis: unmasking a silent risk <p><strong>Background:</strong> Intestinal tuberculosis (TB) remains a global health challenge, especially in regions with a high TB prevalence. This manifestation, distinct from pulmonary TB, involves the gastrointestinal tract, often leading to intestinal obstruction. The study addresses the insidious nature of the disease, emphasizing the urgency for timely diagnosis and intervention. Recognizing the multifaceted impact of TB on various organs, the study explores the pathophysiology, clinical presentation, and diagnostic complexities of intestinal TB.</p> <p><strong>Methods:</strong> This study was conducted at Nalanda medical college and hospital in Patna, Bihar, India, the retrospective study spans three years focusing on 127 patients with intestinal obstruction due to TB. Inclusion criteria prioritized histopathological confirmation of TB, ensuring cohort accuracy. The study employed preliminary investigations, including hemogram, chest X-ray, abdominal X-ray, ultrasonogram, sputum examination, and Mantoux test and CECT whole abdomen. Clinical presentations were systematically analyzed, guiding tailored management protocols based on the mode of presentation.</p> <p><strong>Results:</strong> Demographically, the study identified TB as the cause in 127 cases, with a balanced gender distribution and a peak incidence in the 21-30 years age group. Presentations varied, predominantly with acute symptoms. Common complaints included abdominal pain, vomiting, constipation, and distension. Surgical intervention within 24 hours was crucial in 61.1% of cases. Intraoperatively, findings comprised mesenteric thickening, lymph nodal enlargement, and adhesions. Adhesionolysis was the primary procedure. Postoperative complications, mainly wound infections, were noted but had a limited impact on mortality.</p> <p><strong>Conclusions:</strong> This study reveals TB as a significant contributor to intestinal obstruction, emphasizing challenges in early diagnosis. Adhesionolysis emerges as a key operative procedure, underscoring the need for surgical flexibility. Postoperative complications, while notable, have minimal impact on mortality.</p> Chandrakala Kumari, N. P. Narain Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 08 Mar 2024 00:00:00 +0530 Evaluating maternal and perinatal outcomes of eclampsia at a tertiary healthcare facility in Bihar, India: a retrospective study <p><strong>Background:</strong> Eclampsia, characterized by seizures in women with preeclampsia, is a leading cause of mother and neonatal illness and death globally. Despite advancements in obstetric care, eclampsia remains a significant concern, especially in nations with poor and medium incomes. The aim of the study is to comprehensively assess the maternal and perinatal outcomes associated with eclampsia cases treated at a tertiary healthcare centre with the goal of improving understanding and management strategies for this serious medical condition.</p> <p><strong>Methods:</strong> This retrospective observational study was conducted over 12 months. Data were collected from 200 eclampsia cases, focusing on demographic information, obstetric history, clinical characteristics, obstetric interventions, maternal complications, and perinatal outcomes. Statistical analysis was accomplished using SPSS version 21.</p> <p><strong>Results:</strong> The mean age of patients was 28.5 years, with a majority (65%) being multiparous. Antepartum eclampsia was the most common clinical type (60%). Emergency caesarean section was performed in 70% of cases. Maternal complications included pulmonary edema (45%) and renal failure (25%), with a maternal mortality rate of 5%. Pre-term births occurred in 40% of cases, with an average gestational age at birth of 32 weeks. Additionally, 35% of newborns were low birth weight, and the perinatal mortality rate was 15%.</p> <p><strong>Conclusions:</strong> This study highlights the substantial burden of neonatal and mother morbidity and death related with eclampsia in Bihar, India. Effective management strategies, including timely diagnosis, obstetric interventions, and preventive measures, are crucial in mitigating the adverse outcomes of eclampsia. Improving access to antenatal care, early detection of pre-eclampsia, and enhancing obstetric care services are essential in reducing the impact of eclampsia. Furthermore, continuous medical education programs for healthcare providers can enhance their knowledge and skills in managing eclampsia cases effectively.</p> Priyanka Kumari, Swati, Ashutosh Kumar, Gunjan Gunjan Copyright (c) 2024 International Journal of Research in Medical Sciences Mon, 11 Mar 2024 00:00:00 +0530 Evaluation of antimicrobial activity of Lactobacillus acidophilus and Lactobacillus rhamnosus against clinically isolated Klebsiella pneumoniae: an in vitro study <p><strong>Background:</strong> <em>Klebsiella pneumoniae</em> are Gram-negative opportunistic pathogen, belonging to the family <em>Enterobacteriaceae</em> that can cause severe nosocomial infections particularly in immuno-compromised individuals. They exhibit co-resistance to multiple antibiotics which emphasize the need for non-antibiotic therapies. The goal of the presented study was to investigate the antimicrobial ability of probiotic Lactobacilli on clinical isolates of <em>K. pneumoniae</em>.</p> <p><strong>Methods:</strong> In this cross-sectional study, antimicrobial activities of probiotic <em>L. acidophilus</em> and <em>L. rhamnosus</em> on <em>K. pneumoniae</em> were evaluated by Agar overlay interference technique. Clear zone around Lactobacilli were taken as positive inhibition. Antibiotic susceptibility profiles of <em>K. pneumoniae </em>were determined by Kirby-Bauer disk diffusion method, analyzed using interpretive standards of CLSI M100-S33 and categorized into MDR, XDR and Non MDR groups. Statistical analysis was done using descriptive statistics such as mean and standard error and inferential statistics such as ANOVA single factor.</p> <p><strong>Results:</strong> <em>K. pneumoniae</em> exhibited positive inhibition with both the probiotic strain. On comparing the zone of inhibition of <em>L. acidophilus</em> and <em>L. rhamnosus</em> (both treated-pH adjusted and untreated), <em>L. acidophilus</em> had greater zone of inhibition against <em>K. pneumoniae</em> but concluded that statistically the values are insignificant (p&gt;0.05). Based on antibiotic susceptibility pattern of <em>K. pneumoniae</em>, 63% of isolates were XDR, 3% were MDR and 34% were Non MDR</p> <p><strong>Conclusions:</strong> It can be concluded that <em>L. acidophilus</em> and <em>L. rhamnosus</em> had significant inhibitory effect against <em>K. pneumoniae in vitro</em> and should be further studied for their human health benefit.</p> Anju Anil, Ananthu Raj, Azhar M. M., Nithyamol Kuriakose, Radhika Murali, Harish Kumar K. S. Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Prognostication of Bell’s palsy: a new perspective <p><strong>Background:</strong> Bell’s palsy is considered as the most frequent cranial neuropathy. Early and adequate risk stratification may help both the patients and the treating physicians in taking informed decisions regarding treatment and understanding their outcomes. We aimed to formulate accessible and sensitive methods of risk stratification in Bell’s palsy by utilizing electrophysiological and hematological parameters.</p> <p><strong>Methods:</strong> We prospectively followed up 101 patients with Bell’s palsy over a period of 18 months. Electrophysiological parameters were measured thrice i.e., on the first evaluation and after the first week and first month. The N/L, P/L ratio, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were documented in steroid naïve cases. Patients were graded in severity based on the Sunnybrook and House Brackmann systems.</p> <p><strong>Results:</strong> The mean SB and HB grades at admission were 53.89±24.725 and 3.92±1.04 indicating moderate severity. The mean N/L, P/L ratios and ESR on the first day was 3.46±3.45, 145.42±162.84 and 22.51±21.105 respectively. There was no statistical correlation with severity at any time point. The mean CMAP indices on the 1<sup>st</sup> day, 1<sup>st</sup> week and 1<sup>st</sup> month were 0.585±0.31,0.43±0.26 and 0.45±0.23 respectively. The CMAP index at 1 month was correlating with severity. Blink amplitude ratios were correlating with the HB scores at 1 week and 1 month (p&lt;0.0001 both) and the SB score at 1 month (p&lt;0.0001).</p> <p><strong>Conclusions:</strong> Hematological parameters were not correlated to disease severity. However, electrophysiological parameters are correlated to disease severity at one week and one month. Blink amplitude ratio may be a useful indicator for risk stratification of Bell’s palsy patients.</p> Mary Anne Poovathingal, Percival Gilvaz, Fiju Chacko, Neena Baby Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Effectiveness of structured teaching programme regarding knowledge about uses of menstrual cup among nursing students <p><strong>Background:</strong> Menstruation is a normal biological process experienced by millions of women around the world each month. Good menstrual hygiene practices can prevent infections among women. During menstruation women are using different sanitary products like reusable cloth pads, commercial sanitary pads, tampons, pads made from wool, reusable tampons, and menstrual cups. The menstrual cup was developed as an alternative of sanitary napkins and eco-friendly sanitary product but due to lack of awareness in India it’s uses are very limited.</p> <p><strong>Methods:</strong> Quasi experimental one group pre-test and post-test research design was used in this research study. A total 201 nursing students of were selected by using purposive sampling technique. After the pretest structured teaching programme regarding knowledge of menstrual cap uses was implemented among nursing students and on 10<sup>th</sup> day of STP post-test was done by using the same tools.</p> <p><strong>Results:</strong> During the pre-test researcher found that majority (81.59%) of nursing students had inadequate knowledge regarding menstrual cups uses. The mean knowledge score was significantly (p&lt;0.05) increases from pre-test (7±3.06) to post-test (15±2.36) where mean difference was 8.</p> <p><strong>Conclusions:</strong> The study results highlighted that the STP was highly effective in increase the knowledge among nursing students. Educational intervention programs must give importance in Professional Institutions, which will motivate female’s students to start practice of menstrual cups during menstruation. This is eco-friendly initiative.</p> Ashwini K. M., Atul Kumar Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Efficacy of Dr. SKS hair booster serum for the treatment of hair loss in COVID-19 induced persistent telogen effluvium <p><strong>Background:</strong> Excessive hair shedding occurs in patients with coronavirus disease 2019 induced telogen effluvium. Dr. SKS hair booster serum has demonstrated encouraging benefits in different types of alopecia in previous studies. We sought to evaluate the efficacy of Dr. SKS hair booster serum for the treatment of COVID-19 induced persistent TE.</p> <p><strong>Methods:</strong> A total of 500 patients aged 18 to 60 years who had recovered from reverse transcription-polymerase chain reaction proven COVID-19 infection but experienced sustained hair fall even after 6 months were included in the study. One millilitre of Dr. SKS hair booster serum injection was administered intradermally in scalp per session. Efficacy and safety outcomes were evaluated at baseline, 3 and 6 months after the treatment.</p> <p><strong>Results:</strong> Approximately half of the patients demonstrated excellent improvement in expert panel global photographic assessment at 3 months (vertex area; 43.6% and frontal area; 46%) that was increased at 6 months (vertex area; 48% and frontal area; 50%). Each patient's clinical condition improved. All patients were satisfied with the results in terms of mean total hair growth satisfaction scale score of five aspects at 3 and 6 months treatment.</p> <p><strong>Conclusions:</strong> Intradermal injection of Dr. SKS hair booster serum proves to be effective treatment for hair loss in COVID-19-induced persistent TE.</p> Stuti Khare Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 A clinico-pathological study of minor salivary gland tumors: experience of our institute <p style="margin-bottom: .0001pt; text-align: justify; line-height: normal;"><strong><span style="font-size: 10.0pt;">Background:</span></strong><span style="font-size: 10.0pt;"> Minor salivary glands are found throughout the entire upper aerodigestive tract. Minor salivary gland neoplasms represent less than 25% of intraoral salivary neoplasms. There are no uniform guidelines at present for treatment for minor salivary gland tumors as these are rare entities. The objective of the study was to evaluate the clinicopathological profile of minor salivary gland tumors and to evaluate follow up of patients after treatment.</span></p> <p style="margin-bottom: .0001pt; text-align: justify; line-height: normal;"><strong><span style="font-size: 10.0pt;">Methods:</span></strong><span style="font-size: 10.0pt;"> The present study was a prospective observational study conducted on 11 patients of the Pacific Medical College and Hospital, Udaipur from 1 December 2020 to 31 December 2023 with complaints of intra-oral swelling with biopsy proven MSGT were included.</span></p> <p style="margin-bottom: .0001pt; text-align: justify; line-height: normal;"><strong><span style="font-size: 10.0pt;">Results:</span></strong><span style="font-size: 10.0pt;"> Out of 11 patients, 7 were female and 4 were male. Highest incidence was found in patients in the 4<sup>th</sup>-5th decade of life. For most patients, painless swelling was the primary presentation. The most common site for minor salivary cancer was the hard palate 55%. The most common histological types were adenocystic carcinoma. In 10 cases complete surgical excision with clear margins was the preferred mode of treatment. In 1 palliative therapy was required. Among 11 patients, 2 required radiotherapy.</span></p> <p style="margin-bottom: .0001pt; text-align: justify; line-height: normal;"><strong><span style="font-size: 10.0pt;">Conclusions:</span></strong><span style="font-size: 10.0pt;"> MSGT are rare, early diagnosed and resection with wide margins/neck dissections + SOS adjuvant therapy is key to treatment.</span></p> Sourabh Sharma, Vikesh Kumar, Konark Thakkar, Yugam Prasad Shandilya Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Lower urinary tract symptoms evaluation with uroflowmetry in patients with benign prostatic hyperplasia <p><strong>Background:</strong> Uroflowmetry, a non-invasive urodynamic technique, is commonly employed in evaluating patients with potential lower urinary tract dysfunction. Accurate assessment of the severity of lower urinary tract symptoms (LUTS) can be achieved through the utilization of various validated questionnaires, such as the International Prostate Symptom Score (IPSS). The objective of this study was to investigate the correlation between uroflowmetry parameters and the severity of symptoms.</p> <p><strong>Methods:</strong> Fifty patients with LUTS caused by benign prostatic hyperplasia were evaluated by using uroflowmetry, IPSS, prostate volume estimation from May 2022 to December 2023. The correlations between these parameters were quantified by means of Spearman correlation co-efficients.</p> <p><strong>Results:</strong> Significant statistical correlations were identified between the IPSS and uroflowmetry outcomes, including peak flow rate, average flow rate, and post-void residual urine. However, no correlation was observed between the IPSS and measurements of prostate volume.</p> <p><strong>Conclusions:</strong> A positive correlation was observed between the measured peak flow rate through uroflowmetry and the severity of lower urinary tract symptoms.</p> Shivendra Agrawal, Srinath N., Prathvi, Sreedhar Reddy, Raju L. N., Deepak Bolbandi Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 A study to evaluate the immediate effect of proprioceptive neuromuscular facilitation versus active dynamic stretching during warm-up on 20-meter sprint in amateur soccer players <p><strong>Background:</strong> Soccer is a highly popular sport and is played worldwide. It is an explosive sport and has a high incidence of injuries. In soccer, sprinting dominates the majority of the game, and it imposes a demand on players to have strong, flexible, and dynamic lower limbs. Amateur soccer players don’t usually practice warm-ups before their matches; hence, an appropriate warm-up protocol is required that can be incorporated into the training routine of players to avoid injuries and improve performance. The current study aims to evaluate and compare the immediate effect of PNF stretching versus active dynamic stretching during warm-up on 20-meter sprint performance in amateur soccer players.</p> <p><strong>Methods:</strong> According to the inclusion criteria, 80 amateur soccer players participated in this cross-sectional study design. They were randomly distributed into 2 groups: A) PNF stretching (N = 40) and B) active dynamic stretching (N = 40). Participants in both groups performed the 20-meter sprint test initially, followed by their respective warm-up intervention, after which the 20-meter sprint test was repeated and new readings were recorded.</p> <p><strong>Results:</strong> Both Group A and Group B showed improved performance; however, Group B was significantly better. (p value&lt;0.05).</p> <p><strong>Conclusions:</strong> This study therefore concludes that both PNF and active dynamic stretching can be used as a warm-up protocol. However, according to the inter-group comparison, active dynamic stretching shows a noteworthy improvement in 20-m sprint performance in amateur soccer players.</p> Carol D. Dsouza, Neeraj Kumar Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Renal artery variants: a comprehensive cadaveric comparative study using morphological and corrosion casting technique <p><strong>Background:</strong> Kidneys, crucial excretory organs, receive substantial blood supply through renal arteries. Variations in their anatomy are common, warranting detailed investigation. This study aims to comprehensively examine renal artery patterns using both gross dissection and the corrosion cast method.</p> <p><strong>Methods:</strong> Thirty kidney pairs from cadavers were meticulously dissected at Subharti Medical College, Meerut, U.P. India. Gross features were carefully noted, and corrosion casts were meticulously prepared. Prevalence, origin, level, division, course, and variations were exhaustively recorded to provide a thorough understanding of renal vascular anatomy.</p> <p><strong>Results:</strong> Main renal arteries were found to predominantly originate from the abdominal aorta in all specimens. Interestingly, a higher prevalence of origin of right renal arteries was observed, with 47% exhibiting a higher origin than their left counterparts. Further analysis revealed prehilar division in 38.3% and hilar division in 61.6% of specimens. Notably, a segmental pattern of renal arteries was observed. Accessory renal arteries (8%) were identified, including rare occurrences of bilateral and double accessory renal arteries. Of particular significance was the observation of an accessory renal artery passing anterior to the inferior vena cava, highlighting the intricacies of renal vascular variations.</p> <p><strong>Conclusions:</strong> While reaffirming the conventional understanding of renal arterial anatomy, this study emphasizes the complexity and clinical relevance of variations in renal artery morphology. Such detailed insights are invaluable for surgical and radiological practice, underlining the importance of meticulous preoperative assessment to optimize patient outcomes.</p> Ram Kumar Kaushik, Alok Tripathi, Hina Kausar, Prabhat Goel, Shobhit Raizaday, Pooja Dawani Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 The universal immunization programme coverage and determining factors among tribal children under the age of five in the Wayanad district of Kerala, South India <p><strong>Background:</strong> Globally an estimated two to three million deaths occur every year in all age groups, from six major vaccine-preventable diseases and accounts for almost a quarter of all deaths in children under the age of five years. As Immunization is one of the most successful and cost-effective methods for preventing infectious diseases, the Indian government initiated a vaccination programme to reduce infant mortality and morbidity owing to vaccine-preventable diseases, and achieve vaccine self-sufficiency. In Kerala, about 1.5% of the total population makes up Scheduled Tribes, a socioeconomic group with continuously poor health indicators.</p> <p><strong>Methods:</strong> Through a community-based cross-sectional study using cluster sampling technique, this study intends to determine the coverage of the universal immunization programme among tribal children (0-59 months), the factors affecting vaccination coverage as well as the reasons for partial immunization in Noolpuzha Panchayat, Wayanad. A semi-structured questionnaire was used to collect information from caregivers/mothers.</p> <p><strong>Results:</strong> Out of 289 study population, 64.4% were fully immunized and 35.6% were partially immunized. Children's age and the father's education were found to affect immunization.</p> <p><strong>Conclusions:</strong> As a lack of knowledge about immunizations and subsequent doses was the primary reason for partial immunization. There is a need to create awareness about the importance of vaccination and the subsequent doses among the tribal people of Wayanad.</p> Arun Krishna S. R., Hemapriya A. S., Kalpana S. Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 A comparative study on prevalence of uropathogens and their antibiogram in diabetics and non-diabetics attending a tertiary care hospital <p><strong>Background:</strong> Urinary tract infection (UTI) is a significant problem in both diabetics and non-diabetics. High glucose may create a culture medium for growth of the virulent organisms. Diabetics are at greater risk for developing complications of UTI. Extensive and improper use of antibiotics has caused widespread anti-microbial resistance among uro-pathogens. Indiscriminate use of antibiotics during Covid-19 pandemic might lead to more resistant uro-pathogens which might further complicate the treatment of UTI. This study will help to determine resistance patterns of common uro-pathogens, which is essential for proper patient care.</p> <p><strong>Methods:</strong> Clean voided midstream urine samples were collected from 91 patients (67 diabetic and 24 non-diabetic). Urine cultures were performed using semi-quantitative technique and pathogens were identified using phenotypic methods. Those with colony forming units (CFU) ≥10<sup>5</sup> CFU/ml were subjected to antibiotic sensitivity testing by Kirby-Bauer disk diffusion method and the isolates were classified as sensitive, and resistant according to CLSI guidelines.</p> <p><strong>Results:</strong> <em>E. coli</em> (53.84%) and <em>Enterococci</em> (29.67%) were the most commonly isolated pathogens of UTI in both diabetics and non-diabetics. <em>E. coli</em> resistance to imipenem was statistically more in diabetics when compared to non-diabetics (p=0.012). Resistance patterns of other organisms were similar in both the groups.</p> <p><strong>Conclusions:</strong> <em>E. coli</em> was the most common pathogen isolated in both groups followed by <em>Enterococci</em> and <em>Klebsiella</em>. Diabetics showed statistically significant higher resistance (100%) to imepenem than non-diabetics. Other organisms isolated in this study did not show any statistically significant difference in their antibiogram.</p> Tanmay Anne, Vijayadurga Suryadevara, Anuradha B. Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Detection of colistin susceptibility in extended spectrum β lactamases positive Klebsiella pneumoniae and Escherichia coli clinical isolates by broth disc elution method <p><strong>Background:</strong> Antibiotic resistance is one of the greatest threats in human health. Extended spectrum β lactamases mediated resistance is prevalent worldwide, <em>Klebsiella pneumoniae</em> and <em>Escherichia coli </em>leap out as this significant ESBL producers conferring resistance to the expanded spectrum cephalosporins. Colistin is being administered as last line therapy for patients that have failed to respond to other available antibiotics that are active against Gram-negative bacteria.</p> <p><strong>Methods:</strong> The present study was conducted at school of medical education Kottayam, Kerala from January 2023 to November 2023.During the period of study 150 isolates of <em>K. pneumoniae </em>and 136 isolates of<em> E. coli </em>were collected from various diagnostic microbiology laboratories in Kerala. The colistin susceptibility pattern of ESBL producing isolates was detected by broth disc elution method recommended by CLSI.</p> <p><strong>Results:</strong> In this study prevalence of multi-drug resistant is 6% and 9.6% and Extensively-drug resistant is 62% and 63.9% for <em>K. pneumoniae</em> and <em>E. coli</em> respectively. ESBL production was detected as 72% in <em>K. pneumoniae</em> and 79% in <em>E. coli. </em>The colistin susceptibility pattern of ESBL producing <em>K. pneumoniae</em> and <em>E. coli</em> was detected as 76.9% and 87.9% respectively</p> <p><strong>Conclusions:</strong> Our result demonstrated that the recent use of colistin as last resort treatment for extensively drug resistant gram-negative bacilli, it is essential to know the prevalence of susceptibility pattern to this antibiotic.</p> Aiswarya Sivadas, Anakha Sajeev, Harish Kumar K. S., Shinu Krishnan Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Antibiotic resistance pattern of Pseudomonas aeruginosa isolated from pus samples at tertiary care cancer hospital <p><strong>Background:</strong> <em>Pseudomonas aeruginosa</em> is one of the most frequent opportunistic microorganisms causing infections in cancer patients. The aim of the study was to determine the antibiotic susceptibility of <em>Pseudomonas aeruginosa</em> and multidrug-resistant (MDR) isolates in cancer patients.</p> <p><strong>Methods:</strong> A retrospective study was conducted from January 2022 to December 2022 at Government Cancer Hospital, Aurangabad. A total of 143 pus samples were collected from both IPD and OPD patients. Pus samples were collected as per standard procedure and were inoculated on blood and MacConkey agar. The isolates were identified by standard protocols using biochemical tests. The antibiotic susceptibility pattern of each isolate was checked as per Clinical and Laboratory Standards Institute (CLSI) guidelines 2022 using Kirby-Bauer's disc diffusion method and VITEK 2 Automation. Data analysis was done by statical method with statistical software SPSS version 22.</p> <p><strong>Results:</strong> Out of 143 clinical samples 33 samples (23%) were positive for <em>Pseudomonas aeruginosa</em> growth. mean age of patients was 50 years old out of 33 isolates 12 (36%) isolates were multidrug-resistant, 11 (33%) isolates were extensively drug-resistant and 1 (3%) were pan-drug-resistant. The majority of isolates were responsive to polymyxin B 32 (96%) and colistin 32 (96%); However, the resistance to gentamycin, ceftazidime, and amikacin was higher, at 66%, 60%, and 57%, respectively. </p> <p><strong>Conclusions:</strong> This hospital-based retrospective study will help to implement better infection control strategies and improve the knowledge of antibiotic resistance patterns among clinicians. Thus, there is a need for an antibiotic stewardship program to monitor the resistant pattern in a tertiary care cancer hospital.</p> Kapil V. Surve, Mukta N. Khaparkhuntikar, Nazneen S. Siddiqui, Jyoti A. Iravane Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530 Multivariate analysis of histopathological features as prognostic factors in fifty cases of thyroid neoplasm: a retrospective study done at tertiary care centre <p><strong>Background:</strong> Number of prognostic factors for thyroid carcinoma have been identified including age, gender and tumor characteristics, such as histology and stage. The importance of these factors as independent predictors of survival for patients with differentiated thyroid carcinoma has been extensively studied but remains uncertain.</p> <p><strong>Methods:</strong> A retrospective analysis of 50 thyroid carcinomas was made to assess prognostic factors including histological variants from September 2019 to February 2022 at our centre. The surgical and histopathological data were studied.</p> <p><strong>Results:</strong> 72% patients had papillary thyroid cancer. Multivariate analysis was done and factors showing prognostic significance were tumour size, extrathyroid extension, extranodal extension, lymphovascular, perineural invasion, histological type, necrosis, focality, capsular invasion were found to have poor prognosis.</p> <p><strong>Conclusions:</strong> There are histopathological factors which can modify the course and influence the line of treatment of thyroid neoplasms.</p> Hitesha Bhandari, Anjali Sharma, Rishikesh D. Nilapwar, Praveena G. Vyas, Aditya S. Pawar Copyright (c) 2024 International Journal of Research in Medical Sciences Fri, 29 Mar 2024 00:00:00 +0530