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Background: Subarachnoid block has been used for intracavitary radiotherapy (ICRT) for carcinoma cervix, but the literature on the appropriate dose of local anesthetic required to achieve the desired effect is lacking. We compared two different intrathecal doses of 0.5% hyperbaric bupivacaine (1.2 and 1.5 mL) for providing optimal surgical conditions and readiness to discharge in patients undergoing ICRT for carcinoma cervix. Materials and Methods: This prospective double?blind study was done in 80 patients undergoing ICRT. The patients were randomized into two groups (Groups I and II) to receive 1.2 and 1.5 mL of intrathecal hyperbaric bupivacaine, respectively, for ICRT. The level of sensory achieved, the patient satisfaction score, radiation oncologist score, time to L5 regression, and time to motor recovery (walking unaided) were assessed. Statistical Analysis Used: The data were analyzed using SPSS 20 for Windows (IBM, Chicago, IL, USA). Results: The time taken for the block to regress to L5 (Group I: 134.6 � 32.4 minutes vs. Group II: 143.2 � 43.0 minutes, P = 0.31) were comparable. However, the mean time for walking unaided (Group I: 220.87 � 47.12 minutes versus Group II: 247.00 � 49.83 minutes, P = 0.032) after the subarachnoid block was significantly less in Group I. The patient satisfaction with the procedure and overall satisfaction of the radiation oncologists regarding the operating condition were comparable in both the groups. Conclusions: Hence, a 1.2 mL dose of intrathecal hyperbaric bupivacaine for ICRT provides optimal surgical conditions with hemodynamic stability and ensures the early discharge of the patient.
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Background: Psoriasis is a systemic, inflammatory, chronic autoimmune disease characterized by multiple discoid plaques over body with silvery scales associated with cardiovascular diseases, obesity, diabetes mellitus, hypertension, and hyperlipidemia. Recently, association between psoriasis and Vitamin D level has also been reported. Our aim of study was to evaluate the association of vitamin D and its association with the severity of Psoriasis Materials and methods: 60 patients diagnosed with psoriasis, in our outpatient department from January 2021 to December 2021, were included the study. 58 age, gender- and skin phototype- matched healthy controls were included in the study. Results: The serum vitamin D level in patients and in the control group ranged from 7 to 24 ng/ml (mean: 13.04 �32 ng/ml) and from 16 to 65 ng/ml (mean: 23.91�08 ng/ml), respectively. The circulating vit D levels were less in patients compared to control. The analysis showed statistical significance (P< 0.05) between the two groups. Conclusion: Our results showed decreased level of vitamin D in patients suffering from psoriasis when compared to healthy controls. Vitamin D supplementation can be useful in psoriasis management.
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Abstract Introduction Successful cochlear implantation requires an appropriate insertion depth of the electrode, which depends on cochlear duct length CDL). The CDL can vary due to ethnic factors. Objective The objective of the current study was to determine the CDL in an Indian adult cadaveric population. Methods The present was a cadaveric study using the temporal bones obtained after permission of the Institutional Review Board. The temporal bones were subjected to high-resolution computed tomography (HRCT), and the double oblique reformatted CT images were reconstructed through the basal turn of the cochlea. The reformatted images were then viewed in the minimum-intensity projection (minIP) mode, and the 'A' value (the diameter of the basal turn of the cochlea) was calculated. The CDL was then measured using the formula CDL = 4.16A - 4 (Alexiades et al). The data analysis was performed using the Microsoft Excel software, version 2016. Results A total of 51 temporal bones were included for imaging analysis. The CDL varied from 27.6 mm to 33.4 mm, with a mean length of 30.7 mm. There was no statistically significant difference between the two sides. Conclusion The CDL can be calculated with preoperative high-resolution CT, and can provide a roadmap for effective cochlear implant electrode insertion. The population-based anatomical variability needs to be taken into account to offer the most efficient and least traumatic insertion of the electrode.
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Background: Antenatal care (ANC) services are considered to be the crucial element in the primary health care delivery system of a country. World Health Organization (WHO) estimates suggested that almost all of the maternal deaths (99%) and child deaths (98%) occurred in developing countries. These maternal deaths could have been prevented if the pregnant women or adolescent girls had been able to access quality antenatal care. The objectives of the present study were conducted in rural parts of district Amroha, Uttar Pradesh for assessing the patterns of utilization of the ANC services and to ascertain the factors influencing utilization of ANC services.Methods: The present study was a cross sectional in nature. Recently delivered women were selected as study subject. A multi-stage stratified sampling design with random approaches had been used. Total 360 subjects included in the study.Results: Respondents age, education, occupation, socio economic status, family type and family size were the factors that influenced the utilization of the ANC services. With 100% ANC registration, sub centre was the most preferred place for registration. 76.9% of woman received more than 3 ANC visits. 315 (87.5%) and (71.9%) respondents received 2 doses to TT vaccine and more than 100 IFA tablets respectively.Conclusions: Utilization of ANC services are on rise in rural parts of Amroha, Uttar Pradesh. Still significant proportions of women are doesn’t return to health facility after the ANC registration. Intensification of efforts is needed to cater this left out group through improving community awareness and motivation.
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Background: Developing countries are riddled with poorhealth care infrastructure especially for pregnant women andchildren. Lack of access to quality health care was leading tohigh maternal mortality as well as maternal morbidity. Althoughsituation improved dramatically with the launch of conditionalcash transfer schemes. Prioritizing institutional deliveries overhome deliveries along with other added measures has helpedin changing scenario in short span of time.Objectives: Study was done for assessing the factors thatinfluence women’s decisions regarding their place of delivery,exploring the preferential place for delivery and Contribution ofskilled birth attendant in home deliveries.Methods: The present study was a cross sectional studyconducted in the rural area of Amroha district for a period ofone year from July 2015 to June 2016. Recently deliveredwomen (RDW) were selected as study subject. A multi-stagestratified sampling design with random approaches had beenused. Total 360 respondents participated in the study.Results: Respondents age, education, occupation, socioeconomic status, family type and family size were the factorsthat influenced the place of delivery. The institution was thepreferred place for delivery. Out of total 360 respondents,deliveries conducted in the institution and home were286(79.4%) & 74(20.6%) respectively. SBA attendance at thetime of delivery was impressively low. Just 1 (1.3%) deliverywas conducted by SBA.Conclusion: Institutional births are on rise in rural parts ofAmroha, Uttar Pradesh. Still Significant proportions of birthsare taking place at home despite the government led cashincentive and the other support provided by the healthcareproviders.
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Background: Aim of the study was to study percentage price variations among different brands of the commonly prescribed H2 receptor blockers.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2018 edition, Drug Today April to June 2018 Vol-1. The price ratio and the percentage price variation for individual drug brands was calculated. The price of 10 tablets/capsules were calculated. At last the price ratio and percentage price variation of various brands were compared.Results: Percentage variation in price for H2 receptor blockers marketed in India was found to be tablet cimetidine 200mg:81.89, tablet cimetidine 400mg:91.27, tablet ranitidine 150mg:295.64, tablet ranitidine 300mg:123.19, tablet famotidine 20mg:939.62, tablet famotidine 40mg:1110.09, tablet roxatidine 75mg:38.65, tablet roxatidine 150mg:21.85.Conclusions: H2 receptor blocker is the most common drug prescribed for prolonged period in case of gastritis, Gastro-Esophageal Reflux Disease (GERD), peptic ulcer. If a costly brand is prescribed, the patients have to pay more money unnecessarily for their treatment. The doctors prescribing these drugs should be aware of these variations in price to reduce the price of drug therapy.
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Objective: To develop prediction equations for spirometry for children from northern India using current international guidelines for standardization. Design: Re-analysis of cross-sectional data from a single school. Participants: 670 normal children (age 6-17 y; 365 boys) of northern Indian parentage. Methods: After screening for normal health, we carried out spirometry with recommended quality assurance according to current guidelines. We developed linear and nonlinear prediction equations using multiple regression analysis. We selected the final models on the basis of the highest coefficient of multiple determination (R2) and statistical validity. Main outcome measures: Spirometry parameters: FVC, FEV1, PEFR, FEF50, FEF75 and FEF25-75. Results: The equations for the main parameters were as follows: Boys, Ln FVC = -1.687+0.016*height +0.022*age; Ln FEV1 = -1.748+0.015*height+0.031*age. Girls, Ln FVC = -9.989 +(2.018*Ln(height)) + (0.324*Ln(age)); Ln FEV1 = -10.055 +(1.990*Ln(height))+(0.358*Ln(age)). Nonlinear regression yielded substantially greater R2 values compared to linear models except for FEF50 for girls. Height and age were found to be the significant explanatory variables for all parameters on multiple regression with weight making no significant contribution. Conclusions: We developed prediction equations for spirometry for children from northern India. Nonlinear equations were superior to linear equations.
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Background: Availability of user-friendly statistical software has increased the application of multivariable logistic regression (MLR) in the medical journal many fold. The reporting quality in terms of checking assumptions, model building strategies, proper coding, and report format need proper care and attention to communicate correct and reliable model results. Objective: The objective of this article is to evaluate the quality of MLR article based on 10-point well establish criteria and to study the factors that may influence the quality. Methods: Study included PubMed indexed Indian medical journals as on March 2010 and published at least ten original articles that applied MLR during 10 years was included in the study. Multilevel modeling was applied to assess the role of journal and article attributes on MLR quality. Results: Twelve out of 39 Indian PubMed indexed journals fulfilled the inclusion criterion. Of a total 5599 original articles in these journals, 262 (4.68%) applied MLR in their study. Conformity of linear gradient assumption for continuous covariate was the least fulfilled criterion. One-third of the MLR articles involved statistician or epidemiologist as co-author, and almost same number of MLR articles' first author was from outside India. The trend of 10-point criteria remained consistent although the number of MLR articles increased over the period. The average quality score was 3.78 (95% confidence interval: 2.97-4.60) out of a possible 10. Larger sample size, involvement of statistician as co-author, non-Indian as the first author, and use of SAS/STATA software increased the quality of MLR articles. Conclusions: The quality of MLR articles in Indian medical journals is lagging behind as compared to the quality of MLR articles published from the United States and Europe medical journals. Joint effort of editors, reviewers, and authors are required to improve the quality of MLR in Indian journals so that the reader gets the correct results.
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Necrotizing sialometaplasia is a rare benign and self‑limiting disease, which commonly affects the minor salivary glands. Typically, it involves the seromucinous glands located at palate, buccal mucosa, tongue, tonsil, nasal cavity, trachea, larynx, maxillary sinus, and retromolar trigone. We report two such cases of necrotizing sialometaplasia to create awareness among the pathologists and surgeons because of its close morphological and clinical resemblance to squamous cell carcinoma. We have also documented that, the ischemic necrosis of salivary gland is the result of a vasculitic process.
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We thank Dr Rupa V., Dr Nagoba B.S. and their colleagues for their comments on our editorial.1,2 Both the groups generally agree with our propositions, with Rupa and colleagues suggesting some changes. Credit for authorship is a balancing act between giving credit to all those who deserve it versus avoiding the scourge of ‘gift authorship’. Our editorial recommends credit to all the authors in order to encourage interdepartmental research and to prevent junior researchers from being denied their due which Nagoba and colleagues agree with. Any restriction in this context as suggested by Rupa and colleagues has a potential for harm—with credit being limited to the senior authors, who may be in a stronger position to influence their relative position in the authorship list. One wonders whether in India we have carried the ‘one size fits all’ approach too far in the name of ‘being objective’––and whether a subjective decision by a selection committee based on an individual’s actual contribution (e.g. the volume of work reported in a paper, the multidisciplinary nature of the work, and the expertise of a particular author) may be the way forward. We wish to reiterate that our editorial, written on behalf of the Indian Association of Medical Journal Editors, focused mainly on issues related to the publication process, and not on the criteria for faculty promotions, which is an entirely different debate. However, we emphasize that credit based on impact factor, as suggested by Rupa and colleagues, will pose a fresh set of challenges, given that the concept, application and the potential for manipulation of this measure have been the subject of widespread critique and debate in the literature.
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Measuring academic achievements is never an easy task. This is particularly so when individuals are assessed for promotions in several fields with differing job descriptions. Assessment by peers is time-consuming and may be prone to bias; thus, objective criteria are required to minimize these concerns. The Medical Council of India (MCI) has laid down guidelines for appointments and promotions of teachers in medical institutions in India. Among the criteria used for promotions, publication of research is an essential requirement. Though the need for this requirement has been debated, it is believed that the quality of teaching improves when medical teachers are involved in research. Many countries have made it mandatory for their medical faculty to do research; some other countries incentivize the conduct and publication of research. Reports have also lamented that the physician–scientist might become an endangered species.1,2 Thus, linking publications with promotions might benefit both the individual and society. The flip side is that the time spent on research might take teachers away from teaching or clinical duties, particularly in under-staffed specialty departments. Further, the quality of research is likely to be poor when the resources and training in research are lacking.3 Poor quality may even discredit research as a professional activity. Insistence on a certain amount of published research to maintain teaching credentials may lead to the phenomenon of ‘publish or perish’.4 Finally, it is important to consider that biomedical research may, at times, be relevant to nonbiomedical journals and criteria for awarding credit to such publications should also be devised.
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Measuring academic achievements is never an easy task. This is particularly so when individuals are assessed for promotions in several fields with differing job descriptions. Assessment by peers is time-consuming and may be prone to bias; thus, objective criteria are required to minimise these concerns.
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This editorial is being published simultaneously in the Indian Heart Journal, Indian Journal of Anaesthesia, Indian Journal of Gastroenterology, Indian Journal of Medical Ethics, Indian Journal of Medical Microbiology, Indian Journal of Occupational and Environmental Medicine, Indian Journal of Pathology and Microbiology, Indian Journal of Pharmacology, Indian Journal of Physiology and Pharmacology, Indian Journal of Urology, Indian Pediatrics, International Journal of Health Research & Medicolegal Practice, Journal of Anaesthesiology Clinical Pharmacology, Journal of Ayurveda and Integrative Medicine, Journal of Clinical and Scientific Research, Journal of Conservative Dentistry, Journal of Family Medicine and Primary Care, Journal of Indian Academy of Forensic Medicine, Journal of Mahatma Gandhi Institute of Medical Sciences, Journal of Postgraduate Medicine, National Journal of Integrated Research in Medicine, and The National Medical Journal of India. It may also be published in forthcoming issues of other journals. This editorial is not endorsed by all members of the IAMJE.[Aggarwal R NJIRM 2015; 6(6): 1-5]