Asian Journal of Medical Sciences 2019-07-01T07:20:51+00:00 Dr Arun Kumar Open Journal Systems <p>The inaugural issue of the Asian Journal of Medical Sciences was published in May 2010. Full text articles available.</p> Development of a simple selection protocol for optimizing the harvest of mesenchymal stem cells from explanted human umbilical cord Wharton’s jelly 2019-07-01T07:20:36+00:00 Takhelmayum Paras Singh Mingma Lhamu Sherpa Anup Pradhan Takhelmayum Amumacha Singh <p><strong>Background:</strong> Human umbilical cord Wharton's jelly (hUCWJ) derived Mesenchymal stem cells (MSCs) is a non-controversial, easily available source of human tissue which has a close association with embryonic tissue. Explant culture technique of isolating MSCs do not require any proteolytic enzymes giving an edge when compared to enzymatic methods.</p> <p><strong>Aims and Objective:</strong> This study was designed to develop a suitable protocol to optimize the number of primary cells by transferring the explants after a successful migration and before trypsinizing of MSCs from primary culture plate to new culture plates.</p> <p><strong>Materials and Methods:</strong> For defining the isolated cells as MSCs, the cells were studied by colony forming assay, semiquantitative two steps reverse transcriptase polymerase chain reaction (RT-PCR) and International Society for Cellular Therapy (ISCT) criteria to determine the purity of the lineage.</p> <p><strong>Results:</strong> The explant cultured cells fulfil the defining criteria by ISCT. Further, they form colony and RT-PCR confirmed the presence of thy-1, endoglin and β-actin. The incubated explant shows successful cells migration after transferring from one culture plate to another for five consecutive times. Further, it was seen that the migrated cells can be cultured for more than 18 passages. However, a reduction was seen in the migration of the cells after the 3rd transfer of the explants.</p> <p><strong>Conclusion:</strong> This study found that the transferred explant has the potential to yield cells for 5 consecutive explant transfers. Further, this technique optimized the yield of primary cells and thereby reducing the quantity and frequency of sample collection, processing time and cost.</p> 2019-06-24T00:00:00+00:00 ##submission.copyrightStatement## Relationship between Anthropometric indices, serum Leptin and Respiratory function in Myanmar male adult subjects 2019-07-01T07:20:37+00:00 Thurein Zaw Zarchi Theint-Theint Hlaing Mya Thanda Sein <p><strong>Background:&nbsp;</strong>The role of leptin in respiratory function has been studied in specific respiratory disease. A little is known about the association of serum leptin level and respiratory function parameter in healthy subjects.</p> <p><strong>Aims and Objectives:&nbsp;</strong>This study aimed to investigate the relationship between anthropometric indices, serum leptin and respiratory function in Myanmar male adult subjects</p> <p><strong>Material and Methods:&nbsp;</strong>A community- based cross-sectional comparative study was carried out in 101 apparently healthy male adult subjects of age 18-45 years. All participants were categorized by anthropometric indices into non- obese (body mass index: BMI &lt; 25 Kg/m<sup>2</sup> and obese subjects (BMI &gt; 30 Kg/m<sup>2</sup>). Differences in respiratory function parameter and serum leptin level were compared across the group. <em>Spirobank II</em> spirometer was used to measure respiratory function (FEV<sub>1</sub>, FVC, FEV<sub>1</sub>/FVC, PEFR and FEF<sub>25-75%</sub>). Serum leptin level was investigated by enzyme-linked immunosorbent assay.</p> <p><strong>Results:&nbsp;</strong>The percentage of predicted value of all respiratory function parameters of obese group was significantly lower than that of non-obese group (p &lt;0.05). All respiratory function parameters were significantly and negatively correlated with body mass index (BMI) and waist circumference (WC). Median and interquartile range of serum leptin level in the obese group was 5.8(3.5-9.1) ng/mL and it was significantly higher than that of non-obese group [1.9(1.1-3.1) ng/mL, p &lt;0.001]. Serum leptin level was significantly and negatively correlated with respiratory function parameters (FVC, FEV<sub>1</sub>/FVC, PEF and FEF<sub>25-75%</sub>).</p> <p><strong>Conclusion:&nbsp;</strong>Respiratory function declined with increasing anthropometric indices might be due to increased serum leptin level considered as systemic inflammatory effect of body.</p> 2019-06-21T00:00:00+00:00 ##submission.copyrightStatement## Vitamin B Complex and Homocysteine Levels - A Trend Study Among Asian Indians 2019-07-01T07:20:38+00:00 Sandhya Iyer Prachi Sinkar K Krishnakumar Kallathikumar K Amruta Velumani <p><strong>Background:</strong> Vitamin B complex levels have been strongly correlated with homocysteine status and many studies suggest supplementation with vitamin B to lower cardiovascular risk among adults. However, this relationship does not show a direct trend with many studies concluding otherwise.</p> <p><strong>Aims and Objective:</strong> Our report is an attempt to study association between levels of vitamin B6, folate and B12 in relation to homocysteine in a Pan-India cohort of over 5000 individuals.&nbsp;</p> <p><strong>Materials &amp; Methods: </strong>Data from a total of 5487 Asian Indians including 2942 males and 2545 females were considered for this study. Analysis for levels of vitamins B6 and folate was done using the technology of Liquid Chromatography - Mass Spectrometry (LC-MS), while that for Vitamin B12 and homocysteine was done using the Chemiluminescence Immunoassay (CLIA).</p> <p><strong>Results: </strong>Our analysis identified a clear correlation between vitamin B12 status and levels of homocysteine, while no such trend was observed with vitamin B6 and folate. The total frequency of vitamin B12 deficiency was detected to be 25% of which 50% exhibited clinically high homocysteine levels. The frequency among males was found to be high at 61.6% in comparison to females at 32.3% with the difference being statistically significant at p&lt;0.0001.</p> <p><strong>Conclusion: </strong>Our report is one of the first few to document levels of vitamin B6, folate and B12 in relation to homocysteine in a large Asian Indian cohort. Low levels of vitamin B12 was found to have a greater impact on Hcy levels in comparison to other B-vitamins studied.</p> 2019-06-21T00:00:00+00:00 ##submission.copyrightStatement## Infection associated hemophagocytic lymphohistiocytosis: An institutional experience 2019-07-01T07:20:40+00:00 Kavitha Kanjirakkattumana Parameswaran Shehla Basheer Kollathodi <p><strong>Background:</strong> Hemophagocytic lymphohistiocytosis is an uncommon yet potentially life-threatening disorder. Even though an early recognition of this condition is critical, the diagnosis is often delayed due to a lack of awareness, as well as lack of specific clinical and laboratory features. There is no gold standard for confirmation of a suspected case of HLH.</p> <p><strong>Aims and Objectives:</strong> In this article, we share our experience in infection-associated HLH, in the light of a thorough literature search.</p> <p><strong>Materials and Methods:</strong> We analyzed the clinico-pathological features of 11 consecutive patients who were admitted to our hospital from July 2017 to January 2019 with a diagnosis of HLH. Bone marrow material was collected from all but one case, and the marrow aspirate and biopsy were studied in detail.</p> <p><strong>Results:</strong> There were 9 adult and 2 pediatric patients with HLH. The infections associated with HLH were Dengue fever, Influenza B, and Adenovirus infection. One child had features of severe sepsis, but the causative agent was not identified. Eight out of 11 patients succumbed to the illness.</p> <p><strong>Conclusion:</strong> This study highlights the high mortality rate related to infection associated HLH. Timely diagnosis and early aggressive treatment can improve the clinical outcome of this otherwise potentially fatal condition. Physicians should have a high index of suspicion when patients develop prolonged fever associated with cytopenia and multi-organ involvement.</p> 2019-06-21T00:00:00+00:00 ##submission.copyrightStatement## Device closure of ventricular septal defect: Initial experience in Nepal 2019-07-01T07:20:41+00:00 Chandra Mani Adhikari Manish Shrestha Subash Chandra Shah Amrit Bogati Sachin Dhungel Kiran Prasad Acharya Poonam Sharma Shilpa Aryal Urmila Shakya <p><strong>Background:</strong>&nbsp;Device closure is an attractive alternative in the management of Ventricular Septal defect (VSD).</p> <p><strong>Aims and Objective:</strong>&nbsp;The aim of the study was to access the safety and early outcome of VSD device closure at Shahid Gangalal National Heart Centre, Nepal.</p> <p><strong>Materials and Methods:</strong> The study was single center, retrospective study. All the VSD cases who were attempted for VSD device closure during December 2016 to February 2019 were included. Catheterization laboratory records for VSD type and size, Device type and size were retrospectively reviewed. Hospital records were reviewed for in-hospital complications.&nbsp;&nbsp;&nbsp;</p> <p><strong>Results:</strong> Sixty-one VSD cases were attempted for device closure. VSD was successfully closed in 55 (90.1%) patients. The mean age of the patient was 11.1 years. Twenty-nine (52.7%) were female and 26 (47.3%) were male. Perimembranous VSD in 49 (89 %) and muscular VSD in 6 (11 %) patients. The size of VSD ranged between 2 and 12mm (Mean 5.4mm). The VSD was closed with Amplatzer duct occluder I, Amplatzer duct occluder II, Amplatzer muscular VSD occluder and Memopart PDA device in 24 (43.7%), 26 (47.3%), 4 (7.2 %) and one patient (1.8%) patients respectively. The postoperative complications were insignicant residual leak across device in 2 (3.6%) patients, mild pericardial effusion in one (1.8%) patient. None of the patient had new onset tricuspid regurgitation, aortic regurgitation and complete heart block. One patient developed Right bundle branch block, one developed Left bundle branch block, one developed Junctional rhythm. There was no mortality.</p> <p><strong>Conclusion:</strong> VSD device closure can be safe and effective if patients are selected properly.</p> 2019-06-21T00:00:00+00:00 ##submission.copyrightStatement## Post-Traumatic Stress Disorder among Emergency Medical Services Personnel: A Cross-sectional Study 2019-07-01T07:20:42+00:00 Meshal K Alaqeel Nawfal A Aljerian Muhannad A AlNahdi Raiyan Y Almaini <p><strong>Background:</strong> Post-Traumatic Stress Disorder is characterized by directly experiencing traumatic events or witnessing, learning, or repetitively experiencing the details of these events. High risk occupations (i.e., EMS personnel) frequently encounter traumatic eventscoping with events exceeding the range of human experiences. Regional lack of studies necessitated the need to report the prevalence of PTSD among healthcare providers in Saudi Arabia (SA).</p> <p><strong>Aims and Objective:</strong> To explore the prevalence of PTSD among EMS personnel.</p> <p><strong> Materials and Methods:</strong> This a descriptive cross-sectional study at King Abdul Aziz Medical City (KAMC), Riyadh, SA among 110 paramedics, emergency medical technicians (EMT), and ambulance drivers who were conveniently selected for this screening. Post-Traumatic Stress Disorder Checklist, the Civilian version, (PCL-C) was used to screen the participants, and cut-off point was 30-35. PTSD symptoms (present &amp; absent) was considered as outcome measure.</p> <p><strong>Results:</strong> Total of 110 participants were contacted, 74 (67%) agreed to participate. Around half of the participants were EMT (52%). Total number of screened individuals is 52, 14 (26.9%) had positive screening, of those, EMT had higher proportion than paramedics (32% vs 20.8%).</p> <p><strong>Conclusion:</strong> This report is the first PTSD prevalence among healthcare providers in SA. The results showed that 26% of EMS personnel had positive screening for PTSD. Attention should be directed toward this issue by regular psychological evaluation and implementing psychological rehabilitation programs for EMS personnel. The study reflects only one center in the city, thus generalization would not be inappropriate.</p> 2019-06-20T00:00:00+00:00 ##submission.copyrightStatement## Spectrum of radiological presentations among the patients of intracranial metastasis 2019-07-01T07:20:43+00:00 Shilpi Muchhoria Sourabh Dixit BV Sandeep Suniti Kumar Saha Abhishek Nadkarni Debjyoti Pathak <p><strong>Background:</strong> Brain metastasis has been the most common primary intracranial space occupying lesion (ICSOL) in adult patients.The main systemic malignancies presenting with high tendency to invade brain parenchyma are –lung, breast, melanoma, renal and colon cancers etc.</p> <p><strong>Aims and Objectives:</strong></p> <ol> <li>To study the various radiological presentations in cases of intracranial metatstasis.&nbsp; &nbsp; &nbsp;</li> <li>To assess the radiological presentations to differentiate metastasis from other differential diagnosis.</li> </ol> <p><strong>Materials and Methods:</strong> The present cross sectional study was carried out amongst 32 patients who had been visited tertiary care hospital in Kolkata with radiological features and histopathology suggestive of metastatic lesion.</p> <p><strong>Results:</strong> The mean age of the subjects was 46.56 years and the maximum number of cases presented in 5th and 6th decades of life. CT Scan showed 75% patient had metastatic lesion appearing hyperdense on plain study and 25% had lesion hypodense on plain CT Scan. On T1 weighted images- In 75% of patient the metastatic lesions were hypointense to brain parenchyma and in 12.5% they were isointense and 12.5% they were hyperintense.T2 weighted images- In 62.5% of patient the metastatic lesions were hyperintense to brain parenchyma and in 25% patients they were isointense and in 12.5% they were hypointense. Contrast Images – 37.5% of patients had homogenous enhancement and 50% had heterogeneous enhancement and 12.5% had ring shaped enhancement. In Biopsy about 75% the metastatic lesion turned out to be metastatic carcinoma.</p> <p><strong>Conclusion:</strong> A thorough and systematic approach to radiological investigation is crucial for proper identification of intracranial metastatic lesions.</p> 2019-06-20T00:00:00+00:00 ##submission.copyrightStatement## Menstrual Hygiene: Practice and Challenges Among Adolescent girls of a Private School of Urban Nepal 2019-07-01T07:20:45+00:00 Neeti Singh Ang Tshering Sherpa Srijana Pandey Amita Pradhan <p><strong>Background:</strong> Menstrual health hygiene management (MHM) is the basic right of every female. In developing countries like Nepal, this right is less understood or utilized. Parental and family influences and hence the societal influences plays vital role in behavioral change. In urban sector, the girls studying in the private schools are mostly from privileged background. So there is a need to observe the pattern of practices among private school girls which reflects the scenarios in privileged urban sector.</p> <p><strong>Aims and Objectives: </strong>This study is to explore the practices and challenges for menstrual health hygiene management among adolescent girls of a Private school in Urban Nepal.</p> <p><strong>Material and Methods: </strong>A cross sectional study was conducted in a private school selected purposely in the month of April and May 2019. Girls from grade seven and above were included in the study.</p> <p><strong>Results:</strong> All the girls were aware about the process of menstruation. The practices and believes were influenced by their family and facilities provided to them rather knowledge gained at school. All the participants prefer to use disposal pads and&nbsp;&nbsp; 6.3% of participants reported that they use both pads and reusable cloths. Most girls did not change the pads at school (56.2%). All the participants reported that they were hesitant to take help from teachers due to awkwardness.</p> <p><strong>Conclusions:</strong> Practices of the individuals is influenced by family beliefs. Again, adolescents spend many hours daily in schools. So strict measures to implement facility in schools for MHM should be taken.</p> 2019-06-24T00:00:00+00:00 ##submission.copyrightStatement## AST to platelet ratio index for predicting the in hospital mortality in chronic liver disease patients in tertiary care hospital 2019-07-01T07:20:46+00:00 BS Nagaraja R Madhumati HR Avinash KJ Umesh <p><strong>Background:</strong> Liver cirrhosis is the end result of chronic liver injury. Cirrhosis of liver may progressively deteriorate from a well-compensated state to decompensated conditions.</p> <p><strong>Aims and Objective:</strong> Our study aims at evaluating the AST to Platelet Ratio Index (APRI) for predicting the in-hospital mortality and also comparing APRI, MELD and albumin for predicting in hospital mortality in chronic liver disease.</p> <p><strong>Materials and Methods:</strong> Data of Patients with Chronic liver disease were retrospectively reviewed. MELD and APRI scores were calculated for the patients and results from ROC curves were analysed.</p> <p><strong>Results:</strong> In our study conducted on 299 patients, the age distribution was between 18-64 years with mean age of patients being 46.47+/-10.9 years, sex ratio Male: Female: 266:37 with mortality rate of 17.7%. The area under curves of ROC of APRI, MELD and Albumin are 0.63, 0.76 and 0.55.</p> <p><strong>Conclusion:</strong> APRI is an independent predictor of mortality. The prognostic performance of all 3 was comparable but MELD has better prognostic significance than APRI score.</p> 2019-06-21T00:00:00+00:00 ##submission.copyrightStatement## Evaluation of Antidiabetic potential and Hypolipidemic activity of Coccinia indica (leaves) in Diabetic Albino rats 2019-07-01T07:20:47+00:00 Mamata Pochhi <p><strong>Background: </strong>The whole plant of Coccinia indica is very effective in different types of diseases with fewer side effects. The leaves, roots of this plant were claimed to be useful in the treatment of diabetes mellitus based on folk medicine. The purpose of this study was to examine the antihyperglycemic effect of water extract of C. indica in alloxan diabetes rats.</p> <p><strong>Aims and Objectives: </strong>The aim of this study is to find whether the conditions, hyperglyclemia and hyerlipidemia, are correlated and whether the application of the aqueous extract leads to abating these two conditions.</p> <p><strong>Materials-Methods:</strong> The aqueous leaves extracts of C. indica (200 mg/kg) were administered orally for 14 days, in alloxan induced diabetic rats on Glucose, Lipid profile, Lipoproteins and Lipid metabolizing enzymes activity. &nbsp;</p> <p><strong>Result:</strong> The aqueous leaves extract of C. indica induced significant improvement in glucose, serum Lipids, lipoproteins and lipid metabolizing enzyme activity (HMG CoA reductase, LCAT).</p> <p><strong>Conclusion: </strong>The present study indicates that the extract of Coccinia indica exhibits lipid lowering, maintaining lipoproteins concentration and also improves the activities of lipid metabolizing enzyme in hyperglycemic rats leading to an increase in peripheral glucose consumption.</p> 2019-06-21T00:00:00+00:00 ##submission.copyrightStatement## Prescribing trends in patients of the pain-clinic in a tertiary care teaching hospital, Hapur, Uttar Pradesh 2019-07-01T07:20:48+00:00 Saborni Dey Vivek Sinha Poonam Kachhawa <p><strong>Background:</strong> The drug utilization research is a significant constituent of medical audit which helps in monitoring, evaluating and building required modifications in the prescribing practices to attain a rational and cost effective medical care.</p> <p><strong>Aims and Objective: </strong>The objective of this study was to evaluate drug utilization design of Nonsteroidal anti-inflammatory drugs (NSAIDs) in a tertiary care teaching hospital, SIMS, Hapur.</p> <p><strong>Material and Methods: </strong>This prospective, observational study was conducted in the outpatients of the Pain clinic during six months period to evaluate the prescribing pattern of analgesics in a tertiary care teaching hospital. After getting approval by Institutional Ethical committee, random prescriptions were collected from the OPD and scanned for the record purpose. The demographic data and the prescription were taken from 340 prescriptions. Data was analyzed as per WHO prescribing indicators.</p> <p><strong>Results: </strong>A total 340 prescriptions were analyzed. The result revealed that NSAIDs as Diclofenac (75.21%) and Paracetamol (14.88%) were the most commonly prescribed analgesics. Average number of drugs in the present study was found to be 2.29. Percentage of drugs prescribed generic name was (21.02%). Percentage of encounters with an antibiotic was 12.95%, The use of injectable preparation was around 7.20%. Out of all the medicines, 85.90% were found written from Essential Drug List.</p> <p><strong>Conclusion: </strong>The prescribing trend of NSAIDs indicate some deviation from the WHO recommendations. This touchstone data will be useful to plan more targeted research and to improve prescribing practices. These types of studies help to design policy for rational use of drugs and perioding training programs of physicians, establishing drug and therapeutic committee, drug information centres and regular educational interventions that can be beneficial for improving prescribing practice with rational drug usage.</p> 2019-06-20T00:00:00+00:00 ##submission.copyrightStatement## A study on distribution and gender wise predilection of lip print pattern 2019-07-01T07:20:49+00:00 Sidarth Timsinha Suvarna Manjari Kar <p><strong>Background:</strong> Lip prints are considered as very useful and are to be important forms of transfer evidence like finger prints. Studies have shown that even lip prints are unique for an individual and hence have the potential for personal identification.</p> <p><strong>Aims and Objectives:</strong> To correlate the distribution of lip print pattern and its gender wise predominance.</p> <p><strong>Material and Methods:</strong> The study comprised of 100 Nepalese medical students (50 males; 50 females). A photographic method was adopted rather than the old traditional lipstick method. The photographed lip prints were transferred into a computer to identify the character/lip print pattern. Statistical analysis was done using the SPSS (version 23.0) software package and Chi-square test was applied to evaluate the existence of correlation of lip print pattern with gender.</p> <p><strong>Results:</strong> Type- II lip print pattern was frequently observed in all the four quadrants of both the sexes. This was followed by in order Type-I’&gt;Type-I&gt; Type-IV and Type-III lip patterns. There was a difference in gender wise distribution of lip prints.</p> <p><strong>Conclusion:</strong> Further specific population based and gender specific studies on lip prints with larger sample size are required for comparison of lip prints with gender, so that a database could be created and used for representing sex differentiation.</p> 2019-06-20T00:00:00+00:00 ##submission.copyrightStatement## The burden and underlying determinants of under nutrition among under five year children in Gurage Zone 2019-07-01T07:20:50+00:00 Andamlak Dendir Egata Abdusemd Worku Nida <p><strong>Background:</strong> Malnutrition is one of the most common causes of morbidity and mortality in children under the age of five year. However, in Gurage zone information about the prevalence and associated factors of malnutrition still limited.</p> <p><strong>Aims and Objectives:</strong> The major objective of this study was assessing the burden and determinants of malnutrition among under five children.</p> <p><strong>Materials and Methods:</strong> A community based cross-sectional study design was applied from December 25, 2016 to April 25, 2017. A total of 1040 eligible mothers were interviewed using structured interviewer administered questionnaires by trained data collectors working in pediatrics ward. Through systematic sampling technique study participant were included in the study. To test the existence of statistical relationship between independent and dependent variables multiple logistic regressions analysis was used.</p> <p><strong>Results:</strong> The prevalence of malnutrition among study children was 38.8%. Logistic regressions analysis result indicated that Unimproved sanitation [AOR 1.58 (95% CI 1.13-2.2)], food insecurity [AOR 2.06 (CI 3.49-3.33)], maternal disempowerment [AOR 4.1(CI 2.69-6.24)], inadequate frequency of exclusive breast feeding [AOR 1.9 (95% CI 1.176-3.357]. showed a significant association with malnutrition.</p> <p><strong>Conclusion:</strong> The prevalence of malnutrition among under five year children living in Gurage zone was 38.8%. It was associated with utilization of unimproved sanitation, maternal disempowerment, food insecurity. Hence to abort the problem, it is better to enhance house hold food security, exclusive breast feeding, maternal empowerment and utilization of improved sanitation.</p> 2019-06-21T00:00:00+00:00 ##submission.copyrightStatement## A rare case of tuberculoma masquerading as CP Angle neoplasm 2019-07-01T07:20:35+00:00 Sinjan Ghosh Gautam Guha Kaushik Roy Annesh Bhattacharjee Nikhil Repaka Sourav Nanda Niraja Agasti <p>Tuberculoma involving the cerebellopontine angle is very rare. Preoperative neuroradiological features of such lesions may mimic neoplastic lesions. Our case presented with cerebellar features and multiple cranial nerve palsy. Neuroimaging mimicked CP angle neoplastic lesion. Antitubercular therapy and steroids resulted in significant clinical improvement and marked radiological reduction in size of the lesion. In our subcontinent a treatable infective cause like tuberculosis should be ruled out in CP angle lesions. Although rare but definitely a possibility to be considered.</p> 2019-06-20T00:00:00+00:00 ##submission.copyrightStatement##