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   Table of Contents - Current issue
Coverpage
July-December 2017
Volume 2 | Issue 2
Page Nos. 67-126

Online since Friday, December 15, 2017

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EDITORIAL  

Citation impact: Manipulation and monopoly p. 67
Kusal K Das
DOI:10.4103/bjhs.bjhs_34_17  
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REVIEW ARTICLES Top

Strategies for enhancing quality of life in thalassemic children p. 69
K Kavitha, A Padmaja
DOI:10.4103/bjhs.bjhs_17_17  
Thalassemia is an autosomal recessive disorder characterized by the reduction or absence in the synthesis of the globin chains of hemoglobin. Worldwide, approximately 15 million people are estimated to suffer from this disease and 300 million carriers born every year. The carrier rate for β-thalassemia varies from 1% to 17% in India. The prevalence is very high among certain communities and is emerging as a major public health problem in India but received little attention. Due to the chronic nature of the disease, thalassemic children need long-term treatments such as blood transfusions and chelation therapy. Hence, these children need repeated hospitalization, forgo schooling, and cannot perform day-to-day activities including play. This may affect the quality of life (QoL) in these children. The nursing strategies for enhancing QoL include providing a network of care, supportive strategies, positive coping mechanism, ongoing assessment, prevention of complications, and empowering the children with thalassemia and their parents. The future hopes are unrelated cord blood stem cells, gene therapy. To conclude, a comprehensive approach toward the care of children with thalassemia can increase the level of QoL among these children. The review search was done through Google engine, PubMed as well as scholarly articles from printed journals, and books.
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EMPA-REG OUTCOME trial and Canagliflozin Cardiovascular Assessment Study: Looking beyond the obvious p. 75
Rishad Ahmed, Pallavi Kawatra
DOI:10.4103/bjhs.bjhs_19_17  
With the addition of sodium–glucose cotransporter-2 inhibitors to the current arsenal of oral antidiabetics (OAD), a lot has changed. From questioning their glucouretic mechanism to understanding their pleiotropic effects, it has been an eventful journey. In 2008, after the rosiglitazone fiasco, the US Food and Drug Administration (FDA) mandate was passed to ensure the safety of the OAD. Up to the gliptins, there was an era of cardiovascular (CV) safety which progressed to CV protection with the EMPA-REG OUTCOME trial. It came with a lot of questions regarding the probable mechanism and the doubts of whether it will translate into a class effect or not. After the Canagliflozin CV Assessment Study results, a lot of things have come into light regarding the overall benefits with these molecules. This review highlights the similarities and dissimilarities in the two trial results.
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ORIGINAL ARTICLES Top

Extended longevity at high altitude: Benefits of exposure to chronic hypoxia Highly accessed article p. 80
Gustavo R Zubieta-Calleja, Natalia A Zubieta-DeUrioste
DOI:10.4103/bjhs.bjhs_7_17  
BACKGROUND: Acute exposure to hypobaric hypoxia can give rise to acute mountain sickness, and rarely, high altitude pulmonary edema, and high altitude cerebral edema. However, with gradual adaptation to “chronic hypoxia”, following the Adaptation to High Altitude Formula (Adaptation = time / altitudeΔ), the organism does remarkably well. High altitude residents are perfectly adapted to their environment. The cities of La Paz (3100–4100 m) and El Alto (4100 m) stand as living proof of this with 2.7 million inhabitants living perfectly normal lives, undisturbed by hypoxia and most even unaware of its existence. All the cells of the organism adapt to a lower arterial oxygen arterial partial pressure (PaO2) and likewise to a lower arterial partial pressure of carbon dioxide (PaCO2), an essential component that linked to an increased compensatory hemoglobin explain the paradox of increased “tolerance to hypoxia” at high altitude. METHODS: We reviewed the > 70 years old population historic records of the official Bolivian registration service SEGIP. Two groups were analyzed: those greater than 90 years of age, and those greater than 100 years of age according to the different altitude departments in Bolivia. RESULTS: As the altitude increases, the longevity increases. Santa Cruz at 416m and La Paz at 3800m (average), both with around 2.7 million inhabitants each, have 6 versus 48 centenarians respectively. CONCLUSIONS: Life under chronic hypoxia is not only tolerable, but also is, in fact, favorable to improve or treat many pathological conditions such as asthma, coronary artery disease, obesity and even giving rise to improved longevity. Sea level residents (when compared to high altitude residents) suffer a disability: poor tolerance to hypoxia.
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Is it possible to avert arsenic effects on cells and tissues bypassing its toxicity and suppressive consequences of energy production? A hypothesis p. 91
Biplab Giri, Sananda Dey
DOI:10.4103/bjhs.bjhs_28_17  
Arsenic, a sulfhydryl reactive metalloid, found primarily in two forms: arsenite and arsenate, causing several human health problems, is considered as a dreaded agent against public health. It mainly spreads through groundwater contamination and affects human mainly through drinking water. Arsenic contaminated groundwater is now a major threat in some parts of India (the river basin of Ganga and Brahmaputra) and Bangladesh. The current authors belong to the region where arsenic poisoning and its consequences are spreading in an uncontrolled way. We are helpless to stop the spreading of geogenic groundwater arsenic contamination at present. Although most of the research on arsenic removal from drinking water and on toxicity profile has been carried out, very few preventive measures have been reported till date to balance the arsenic-induced cellular energy deficiency and oxidative stress-mediated cell death and cellular senescence. And, therefore, we need to think about alternative remedial to address such problems, which propel us to propose the current hypothesis that the adverse effects of energy imbalance due to arsenic toxicity in cells could be dodged by intake of moderate amount of alcohol. While pyruvate dehydrogenase complex is blocked by arsenic, glucose cannot be utilized through Kreb's cycle. However, alcohol can produce energy by bypassing the aerobic adenosine triphosphate (ATP) production machinery. In addition, arsenic poisoning incurs cellular oxidative stress which needs to be scavenged further. So to meet this secondary problem, we also suggest consuming red grape juice (a potent antioxidant and cytoprotective agent) in addition to alcohol (as per International Center for Alcohol Policies (ICAP) Drinking Guidelines) in our second part of the hypothesis. In conclusion, it can be suggested that the red wine which contains moderate amount of alcohol and high levels of red grape polyphenols, galic acid, resveratrol, and other antioxidants could be the best alternative to tackle the arsenic-induced cellular aging, senescence, and death.
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Patients' rights in an underserved Nigerian environment: A cross-sectional study of attitude and practice orientation of medical professionals in Abia State p. 97
Gabriel Uche Pascal Iloh, Agwu Nkwa Amadi, Miracle Erinma Chukwuonye, Chukwuneke Valentine Ifedigbo, Udo Nnorom Orji
DOI:10.4103/bjhs.bjhs_20_17  
BACKGROUND: Globally, medical care have an age long history, but the rights of patients are more recent and occupy front burner in the quality of care metrics and medical jurisprudence and are on the rise, particularly in emerging and developing economies. AIM: The study was aimed at describing the attitude and practice of patients' rights among medical professionals in Abia State, Nigeria. MATERIALS AND METHODS: A descriptive study was carried out on a cross-section of 185 medical practitioners in Abia State, Nigeria. Data collection was done using pretested, self-administered questionnaire that elicits information on awareness, attitude, and practice of basic patients' rights. Each item of attitude and practice of patients' rights was scored on a five-point Likert scale ordinal responses of all-times, most-times, sometimes, rarely, and none. Attitude and practice of patient's rights were assessed in the previous 1 year. RESULTS: The age of the participants ranged from 28 to 71 years. There were 166 males and 19 females. All the participants were aware of the patient's rights. The overall positive attitude to patients' rights was 87.3% with the most common positive attitudinal orientation being right to confidentiality (100.0%), and the least was right to know the identity/professional status of the physician (52.4%). The overall practice of patient rights was 85.8% with the most commonly practiced being right to confidentiality (100.0%) and the least was right to know the identity/professional status of the physician (51.4%). Attitude (P = 0.037) and practice (P = 0.048) of the right to know the identity/professional status of the physician were significantly associated with >10 years of medical practice. CONCLUSION: The level of awareness of patient's rights was very high but did not translate to comparative overall positive attitude and practice orientation. Patient rights should be the focus of intensive continuing medical education and professional development in addition to greater administrative and governmental support, especially in developing economies where there are limited options to safeguard patients' rights.
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MEDICAL EDUCATION TEACHING NOTE Top

Students' responses under “negative pressure” to respiratory questions at the 15th physiology quiz international event: 100 medical school teams from 22 countries p. 105
Hwee-Ming Cheng, See-Ziau Hoe
DOI:10.4103/bjhs.bjhs_27_17  
The annual Inter-medical School Physiology Quiz (IMSPQ) reached a milestone in August 2017 with the participation of 100 university medical schools at the 15th IMSPQ. A total of 440 students from 22 countries competed. The written test on day 1 shortlisted 48 of the 100 teams for the 2nd day oral quiz stimulating sessions, conducted before a live audience. The IMSPQ provides a unique sample of international students, taught under a diverse spectrum of medical curriculums, designed to meet the university and national priorities of the countries. The written test, taken by all 440 students, is a challenging 75-min paper with 100 physiology statements covering all organ systems. Certainty in students' answers was targeted by a true/false response, with no marks for unattempted questions but with a negative mark on incorrect answers. The insights from an analysis of responses to the lung physiology, including cardiorespiratory mechanism, are helpful and enlightening for Physiology teachers. They show common areas of difficulty and imprecise understanding. This brief teaching note will describe and give some comments on the students' respiratory responses under pressure of negative marking.
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CASE REPORTS Top

Restoration of anterior esthetics with Richmond crown p. 109
Faisal Khan, Sunil Kumar Mishra
DOI:10.4103/bjhs.bjhs_16_17  
Conservation of natural tooth is the main focus of the present era of dentistry, and endodontist and prosthodontist play a major role in conserving and restoring tooth function and esthetics. Restoring grossly destructed endodontically treated teeth is a challenge in restorative dentistry. Restoring such compromised teeth often requires additional support from the root canal with the help of post and core restoration. This case report describes a patient with grossly decayed central incisor and reduced interocclusal space treated with Richmond crown.
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Pregnancy tumor: A rare case report in mandibular anteriors p. 112
Swati Phore, Rahul Singh Panchal
DOI:10.4103/bjhs.bjhs_13_17  
Pregnancy in a woman's life is associated with a variety of physiological, anatomical, and hormonal changes that can affect the cardiovascular, respiratory, and gastrointestinal systems. Such hormonal changes may lead to periodontal diseases and may be associated with generalized or localized gingival enlargements. Pregnancy does not cause the condition, but altered tissue metabolism in pregnancy accentuates the response to the local irritants, thereby causing gingival enlargements. In this report, a 25-year-old pregnant female had a localized gingival enlargement in the labial aspect of the mandibular anterior region.
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Incidental upper tract urothelial carcinoma presenting as pyonephrosis p. 115
K Manjula, Geethanjali Nagaraj, Krishna Shetty, CSBR Prasad
DOI:10.4103/bjhs.bjhs_2_17  
Upper tract urothelial carcinomas (UTUCs) are uncommon and account for only 5%–10% of urothelial carcinomas. The most common symptom of UTUC is gross or microscopic hematuria (70%–80%). A 55-year-old woman admitted with the history of fever and pain in abdomen for the past 20 days. Her history was not significant. She underwent right nephroureterectomy with the provisional clinical diagnosis of pyonephrosis with nonfunctioning kidney. Histopathological examination of nephrectomy specimen showed features of high-grade urothelial carcinoma with renal parenchyma invasion (T3N0M0). Here, we present a rare case of incidental UTUC presenting as pyonephrosis.
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Rectus sternalis p. 118
Varun Rajesh Sarodaya, Tanveer Abdul Majeed
DOI:10.4103/bjhs.bjhs_24_17  
The sternalis muscle is an uncommon variant of the anterior thoracic chest wall musculature. During mastectomy of a patient, we observed a left-sided unilateral vertical band of texture sternalis muscle fiber overlying the lateral edge of the sternum. We are reporting about the same in this case. The origin of this muscle is a debatable topic. It can be misdiagnosed by the clinicians on a routine mammography. The presence of this muscle can cause alterations in electrocardiography during investigation.
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LETTERS TO EDITOR Top

Dental caries: Early childhood caries, a cause for concern p. 121
Ibrahim Aliyu
DOI:10.4103/bjhs.bjhs_21_17  
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Three pioneers behind statistical methods commonly used in biomedical research Highly accessed article p. 123
Himel Mondal, Shaikat Mondal
DOI:10.4103/bjhs.bjhs_15_17  
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Diagnosis of smokers' palate in a denture wearer patient p. 125
Shail Kumari, Sunil Kumar Mishra
DOI:10.4103/bjhs.bjhs_18_17  
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