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   2014| October-December  | Volume 3 | Issue 4  
    Online since December 10, 2014

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Antioxidant supplementation for health - a boon or a bane?
Uppala Satyanarayana, Amar Nagesh Kumar, Jupalle Nagaiah Naidu, Devavarapu Kasi Viswa Prasad
October-December 2014, 3(4):221-230
Antioxidants (vitamins E and C, β-carotene, superoxide dismutase [SOD], catalase etc.) are the substances that protect cells from the damage caused by free radicals, formed as a result of oxidative stress. Free radicals (O 2 , H 2 O2, OH , ROO etc.) are generated during the cellular metabolism and also due to environmental effects (cigarette smoke, ionizing radiations). Excessive production of free radicals has been implicated in the causation and progression of several diseases, e.g., atherosclerosis, cancer, rheumatoid arthritis, diabetes, and cataract. The general belief is that since free radicals are bad for health, antioxidants are good. This led to an indiscriminate use and supplementation of antioxidants, which is currently a controversial issue. This review gives an updated information on the effects of supplementation of antioxidants (vitamins E and C, β-carotene, SOD, catalase etc.). While some studies suggest that antioxidants are beneficial and protective, other interventional trials showed no health benefits. There are some interventional studies which demonstrated the deleterious effects of antioxidants (high risk of cancer, increased mortality). Further, antioxidant supplements were found to diminish the beneficial effects of certain drugs. It is suggested that indiscriminate use of antioxidant supplements should be avoided. Perhaps, antioxidants may be prescribed (not exceeding the recommended daily allowance) to the elderly, strict vegetarians or people who are on calorie-restricted diets. It is advisable that the antioxidants are consumed from rich natural dietary sources rather than supplements. Further, healthy individuals should exercise utmost caution while overdosing themselves with antioxidant supplements.
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Morbidity profile of long distance truck drivers in Hyderabad city, India
Sharma Pawan Kumar, Enakshi Ganguly
October-December 2014, 3(4):234-237
Context: Truck drivers in India suffer from multiple health problems related to their long travelling and inadequate rest hours. Aims: The objective was to study the health problems and risk factors in a sample of truck drivers in Hyderabad city. Materials and Methods: A cross-sectional study was conducted during June 2011 among 59 truck drivers from a transport company, who were interviewed using a pretested proforma and examined by trained investigators. Lab results and medical consultations were provided the following day. Results were analyzed using Microsoft Access software. Results: The mean age of truck drivers was 28.46 ± 9.3 years. 54% suffered from low backache, 16.95% from visual problems, 45.76% had hypertension, 8.47% had anemia and 30.51% had high-risk body mass index. The prevalence of risk factors for metabolic disorders was lower compared to the general population. Conclusion: Proper road and job policies for truck drivers should be framed, aiming at subjecting them for periodic health evaluations to detect the diseases early.
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Neonatal sepsis: A risk approach
Vijai Anand Babu Bangi, S Syamala Devi
October-December 2014, 3(4):254-258
Background: Neonatal sepsis continues to be a major cause of neonatal mortality in India. Incidence of neonatal sepsis in India was 30/1000 live births and is not changed much over the past decade. Aims and Objectives: The present study was intended to know the incidence and mortality rates of neonatal sepsis among hospital admission, whether there is any change in the risk factors over a decade and to evolve a risk approach in the management of neonatal sepsis. Patients and Methods: This was a cross-sectional study in a tertiary care teaching hospital. One hundred and twenty neonates with confirmed sepsis were enrolled. Cases were divided into early onset sepsis (EOS) (presenting in the first 72 h) and late onset sepsis (LOS) (presenting after 72 h). Information regarding risk factors was collected by questionnaire. All cases were started on ampicillin and gentamycin later upgraded based on culture and sensitivity. Cases were followed-up to discharge/death and the risk factors associated with fatal sepsis were analyzed using Chi-square test. Results: During 2003-2004, the incidence of sepsis was 6.04% of total pediatric admissions with EOS and LOS 3.08% and 2.96%. The same in 2013-2014 were 6.03%, 2.57% and 3.44%, respectively. Highly significant risk factors were inadequate antenatal care, assisted vaginal delivery, and premature rupture of membranes, low birth weight and associated complications. Klebsiella, Staphylococcus aureus and Escherichia coli were the most common organisms in both EOS and LOS. Conclusion: Overall incidence of sepsis and EOS is not changed much but the incidence of LOS has increased from 2.94% to 3.44%.
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Maternal luteoma of pregnancy: A rare case report
R Vinay Kumar, D Siva Ranjan, B Rao, Epari Sanjeeva Rao
October-December 2014, 3(4):267-269
Pregnancy luteoma is a rare non-neoplastic tumor like mass of the ovary. They are usually asymptomatic and found incidentally during imaging or surgery. They regress spontaneously after delivery. We present a case in a 28-year-old female patient with an ovarian mass, which was found incidentally during cesarean section. Histopathological examination showed features of luteoma of pregnancy. Recognition of this entity is important so that unnecessary oophorectomy, with concomitant risk to both the mother and the fetus, is avoided.
  3 3,725 268
Idiopathic multiple unerupted permanent teeth: A rare case report
Sandra Vani, Anitha Nooney, Kakarla Subba Raju, Melpati Hemadri
October-December 2014, 3(4):283-286
A disturbed eruption process creates a clinical situation that is challenging to diagnose and treat. The clinical spectrum of tooth eruption disorders includes both syndromic and nonsyndromic problems ranging from delayed eruption to a complete failure of eruption. Failure of permanent teeth to erupt without obvious etiology is a rare dental anomaly. Various local and systemic factors have been implicated in failure of eruption of multiple permanent teeth. The present case report discusses the clinical and radiographic details of a 21-year-old asymptomatic and nonsyndromic patient with multiple unerupted permanent teeth.
  1 7,134 615
Intracranial hydatid cysts-some rare presentations of cases
Ramanjulu Mala, ML Ananth, BN Nagaraju, C Venkateswara Rao
October-December 2014, 3(4):263-266
We are here with presenting four cases of intracranial hydatid cysts that are managed at Department of Neurosurgery, Government General Hospital Kurnool between 2010 and 2013. The mean age of presentation is 25 years. One patient had primary solitary cyst, second patient had primary unilateral multiple cysts, third patient had secondary (metastatic) bilateral multiple cysts and fourth had secondary multiple cysts presenting with unilateral proptosis. All patients were presented with signs of raised intracranial pressure. Radiological investigations included computed tomography and magnetic resonance imaging.
  1 2,704 196
Study of significance of anti-cyclic citrullinated peptide antibody in rheumatoid arthritis
Tammakota Kanakadurgamba, Indugula Jyothi Padmaja, Nitin Mohan, Sarath Veeravalli
October-December 2014, 3(4):238-242
Background: Early aggressive therapy is recommended for rheumatoid arthritis (RA). Rheumatoid factor (RF) is not very specific for RA diagnosis. Another test for RA diagnosis is assay for anti-cyclic citrullinated peptide antibodies (anti-CCP). Aims: Screening for anti-CCP and RF in clinically diagnosed RA patients and to determine the correlation between presence of these antibodies and joint erosion. Materials and Methods: Sera from 83 clinically diagnosed RA patients (by American College of Rheumatology 1987 criteria) were tested for RF and anti-CCP antibodies by commercially available latex agglutination and enzyme-linked immunosorbent assay kits, respectively. Results: Onset of RA at young age was seen (P < 0.05). Seropositivity for anti-CCP in present study was 76%. Patients seronegative for RF but reactive to anti-CCP were 27.7%. Joint erosion was observed in 81.92% of RA cases. Joint erosion was more common in anti-CCP positive patients (P < 0.001). Joint erosion was observed in all (100%) patients who were seropositive for both RF and anti-CCP. Conclusions: Anti-CCP antibody supports the diagnosis of RA when RF is negative. Joint erosion was observed to be more in RA cases seropostive for anti-CCP. Combined use of RF and anti-CCP is a better prognostic and diagnostic tool than conventional RF tests alone.
  1 2,694 261
Evaluation of mast cells and eosinophils in odontogenic cysts: A histochemical approach
Madhusudan Astekar, Junaid Ahmed, Rashmi Metgud, Khushboo Phull, GV Sowmya
October-December 2014, 3(4):243-248
Background: Odontogenic cysts and tumors are most common benign destructive lesions in the oral cavity. These cystic lesions with its central fluid, reservoir of non-physiological composition, is in itself likely to provoke an inflammatory response in the surrounding host tissues, which may result in its formation and enlargement. Aims and Objectives: 1. To evaluate the number of mast cells and eosinophils in radicular cyst, keratocystic odontogenic tumor and dentigerous cyst and to intercompare it with the degree of inflammation. 2. To evaluate and intercompare the staining quality of toluidine blue and thionin for mast cells identification and Carbol Chromotrope and Congo red for eosinophils evaluation. Study Design: The study comprised of total 47 cases of which 20 were of radicular cyst, 15 were keratocystic odontogenic tumor and 12 were dentigerous cyst. Sections of 4μm thick were cut and stained with gold standard hematoxylin and eosin staining procedure for routine diagnosis. The amount of inflammation in each cyst was graded. They were further stained with toluidine blue and thionin for mast cells identification and Carbol Chromotrope and Congo red for eosinophils identification. The statistical analysis used was one way ANOVA (Analysis of Variance) and Pearson's Correlation Coefficient. Results: The mean number of cell count per high power field of mast cells was higher than the eosinophils. On correlating with degree of inflammation the results came out to be statistically significant. The staining quality for mast cells was equally good with toluidine blue and thionin, whereas Carbol Chromotrope had a significantly better staining quality than Congo red in case of eosinophils. Conclusion: The higher number of mast cells detected in odontogenic cysts could contribute in the release of inflammatory mediators involved in the pathogenesis of odontogenic cysts formation and enlargement. The histochemistry using various stains has proved to be promising in identification of mast cells and eosinophils.
  1 3,484 456
A case of unilateral thalamic venous hemorrhagic infarct in deep venous system thrombosis
Anirudda Deshpande, Aakash Shetty, Amith Sitaram, Supriya Khardenavis
October-December 2014, 3(4):259-262
Cortical venous thrombosis (CVT) is a common and frequently unrecognized type of stroke that affects approximately five people per million annually and accounts for 0.5-1% of all strokes. Exact incidence in India is yet to be documented. Puerperal CVT may account for the majority of CVT cases in India. Cerebral venous sinus thrombosis (CVST) usually affects young to middle aged groups. Outcome of CVST patients may vary from complete recovery to permanent neurological deficits, with varying presentation of the natural course of the disease. Factors related to poor outcome were papilledema, altered consciousness, coma, age older than 33 years, diagnostic delay >10 days, intracerebral hemorrhage, and involvement of the straight sinus. This case report is of thrombosis in the deep venous system of brain causing venous infarction of unilateral thalamus. There are very few cases reported all over the world with unilateral thalamic venous infarct. Prognosis of unilateral deep cerebral vein thrombosis is said to be better than that of bilateral thrombosis, if detected early and timely treated. Patient with a unilateral thrombosis may show complete recovery from his neurologic symptoms. Reports of reversible edema of the thalamus are well documented. In this case, patient is overall well preserved except that he continues to have recent memory impairment even after 4 weeks of discharge from hospital.
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Gingival overgrowth associated with port-wine stains: A case report of Sturge-Weber syndrome
Panthula Veerendranath Reddy, Koduganti Rekha Rani, Pinnamaneni Indumathy, Dasari Rajashree
October-December 2014, 3(4):287-290
Sturge-Weber syndrome is a rare neurocutaneous disorder, also known as encephalotrigeminal angiomatosis. It has varied systemic and oral manifestations, and the management of oral condition in such a case is a dental practitioner's challenge. In this case report, we describe a rare clinical presentation of Sturger-Weber syndrome with dermatological and intraoral manifestations, but without any neurological involvement.
  - 3,529 255
A young lady with an intriguing limp: Solitary neurofibroma of the femoral nerve
Nagarjunakonda Venkata Sundarachary, Amalakanti Sridhar, Pokala Vijayalakshmi, Inuganti Venkata Renuka, Yekula Kiran Kumar
October-December 2014, 3(4):270-272
Solitary neurofibromas are a part of neurofibromatosis. They are present in a variety of ways. We report a case of a solitary plexiform neurofibroma of the femoral nerve, which eluded diagnosis for 4 years.
  - 2,507 179
Mixed beriberi: Sub acute cardiac beriberi with neurological involvement
Pothukuchi Venkata Krishna, Shaik Ahmed, Venkata Ravikumar Chepuri
October-December 2014, 3(4):273-275
We present a case of mixed beriberi, with cardiac and neurological involvement (dry beriberi). Prolonged Thiamine deficiency causes beriberi, which is classically categorized as wet or dry; although, there is considerable overlap. In either form of beriberi, patients may complain of pain and paresthesia. This is a treatable condition sometimes with incomplete recovery, but it is probably under recognized yet increasingly common due to increasing levels of alcohol abuse. The disorder is a metabolic emergency and requires immediate treatment with intravenous thiamine. Sudden cardiac failure is common. Death occurs from right heart failure and the patient usually dies fully conscious. This patient was successfully treated with intravenous thiamine.
  - 3,857 180
Unusual foreign body of skull base by a penetrating injury of oropharynx
Krishna Chaitanya Vemuru, Krishna Kumar Markapuram, Ramakrishna Tirumalabukkapatnam, Janardhan N Nara
October-December 2014, 3(4):276-279
Brushing of teeth has become an integral part of our daily routine and is regarded as very safe even in children. Tooth brush is made up of relatively pliable material and has a smooth surface and round corners and is designed in such a way that it should not harm the delicate tissues of the oral cavity. Keeping the toothbrush in the mouth and doing other works with both arms may lead to injury of the oral tissues. Toothbrush injury has been reported in children who have slipped and fallen down with the tooth brush inside their mouth. Very rarely, it occurs in adults with the belief that the adults will be careful, while brushing their teeth. It is rare to see a penetrating injury in the oral cavity with a tooth brush. It is much rarer to see such penetrating foreign body going through neck spaces that too within the vicinity of great vessels. Here is a case wherein a penetrating injury of the oropharynx and neck spaces by a tooth brush has been encountered and is being reported for its rarity.
  - 2,083 231
Atopic dermatitis and psoriasis vulgaris occurring in same families
Rajyalaxmi Konathan, A Sainath Kumar
October-December 2014, 3(4):280-282
Psoriasis and atopic dermatitis (AD) are chronic and relapsing inflammatory diseases of the skin associated with various immunologic abnormalities. Psoriasis is driven by type 1 helper T and type 17 helper T cells, while AD is driven by type 2 helper T cells. Simultaneous occurrence of psoriasis vulgaris and AD in same families is not very rare but commonly missed entity. We are reporting nine cases of AD and psoriasis vulgaris occurring in same families.
  - 2,333 198
Iodization of salt is a safe and successful strategy which has been tested and proven
Ajeet Singh Bhadoria, Umesh Kapil
October-December 2014, 3(4):291-292
  - 1,423 136
Reply: Iodized salt, a boon or bane?: A retrospective study
Seshaiah Venkata Kurada, Srinivasa Rao Dana, Eswar Ganti, Srijana Pakalapati, Madhavi Pothukuchi
October-December 2014, 3(4):293-294
  - 1,502 124
Haemoglobin E/β-thalassemia
Sudhasmita Rauta, Aswini Kumar Sahoo
October-December 2014, 3(4):295-296
  - 2,022 141
Maternal and fetal outcome in jaundice complicating pregnancy
Morthala Greeshma Reddy, GC Prabhakar, Vijaya Sree
October-December 2014, 3(4):231-233
Objective: This study is aimed at determining maternal and fetal outcome in women with jaundice complicating pregnancy. Materials and Methods: An analysis of maternal and fetal outcome of 18 pregnant women admitted with jaundice during June 2012 to May 2013. Results: All cases in this study were in their third trimester of pregnancy. Serum bilirubin was >10 mg in 8 (44.4%) cases. In patients with jaundice related to pregnancy serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase and alkaline phosphatase were raised in a majority of them. Hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, acute fatty liver of pregnancy, intrahepatic cholestasis of pregnancy, viral hepatitis, malaria and sickle cell anemia were the causes of jaundice in this study. In this study, HELLP syndrome (33.3%) was the most common cause of jaundice. Of 18 women, 10 (55.6%) of women the onset of labor was spontaneous and 16 (88.9%) delivered vaginally. Perinatal mortality in 6 cases (33.3%) among them 1 (16.6%) stillbirth and 5 (83.3%) intrauterine deaths. 15 (83.3%) women were discharged in improved condition. Maternal mortality in 3 cases (16.66%) 1 case died within 24 h of delivery, 1 on the 4 th postnatal day and 1 on the 8 th postnatal day. Cause of death was acute fatty liver of pregnancy with multiorgan failure with disseminated intravascular coagulation (DIC) with shock in 2 cases, HELLP syndrome with DIC with renal failure in 1 case. Conclusion(s): Jaundice and pregnancy is a deadly combination resulting in a very high perinatal as well as maternal morbidity and mortality, and requires an early diagnosis and careful management.
  - 18,201 854
Association between chronic periodontal disease and cardiovascular risk factor hyperlipidemia
Anitha Akkaloori, Parthasarathi Parthasarathi, Mohammad Shakeel Anjum, Praveen Gadde, Monica Mocherla, Yadav Rao
October-December 2014, 3(4):249-253
Background: Periodontal disease is one of the major reasons for tooth loss. Accumulating evidence suggests that chronic infections, such as periodontitis, are associated with increased risk for cardiovascular diseases (CVD) possibly through providing a systemic inflammation and found that 25% to 50% increase in risk of CVD for those with periodontitis when compared to those with no or minimal periodontitis. Aim: To evaluate the association between chronic periodontal disease and cardiovascular risk factor such as hyperlipidemia. Materials and Methods: A hospital-based study was conducted among the patients who came to the out-patient department. Fifty subjects including both males and females were selected by systematic random method, and community periodontal index was recorded on all subjects. Subjects were divided in to healthy group (controls) and chronic periodontitis group (cases) based on presence/ absence of loss of attachment. Blood samples were collected from all subjects for the measurement of lipid profile in the serum. Results: Mean total cholesterol values in controls and cases were 190.44 and 200.64, which were not statistically significant between the groups. Mean LDL cholesterol values in controls and cases were 110.96 and 136.64, which were statistically increased in cases (P = 0.003). Mean HDL cholesterol values in controls and cases were 61.60 and 49.28, which were statistically higher in controls (P = 0.041). Conclusion: Chronic periodontitis patients may have high risk of getting cardiovascular diseases since cardiovascular risk factors such as total cholesterol and LDL are associated with periodontitis.
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