Asian Journal of Medical Sciences https://www.nepjol.info/index.php/AJMS <p>The inaugural issue of the Asian Journal of Medical Sciences was published in May 2010. Full text articles available.<br>AJMS was added to <a href="https://doaj.org/toc/2091-0576" target="_blank" rel="noopener">DOAJ</a> on 26th May 2020.</p> <p>AJMS was added to CAB Abstracts and/or Global Health database on 15th December 2020. Coverage will start from Volume 11, No. 1, 2020 onwards.</p> Asian Journal of Medical Sciences Pokhara en-US Asian Journal of Medical Sciences 2467-9100 <p>Authors who publish with this journal agree to the following terms:</p><ol start="1"><li>The journal holds copyright and publishes the work under a Creative Commons <a title="CC-BY-NC" href="http://creativecommons.org/licenses/by-nc/4.0/" target="_blank">CC-BY-NC license</a> that permits use, distribution and reprduction in any medium, provided the original work is properly cited and is not used for commercial purposes. The journal should be recognised as the original publisher of this work.</li><li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li><li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a href="http://opcit.eprints.org/oacitation-biblio.html" target="_new">The Effect of Open Access</a>).</li></ol> Shaping the Landscape of Eukaryotic Gene Expression: Horizontal Gene Transfer https://www.nepjol.info/index.php/AJMS/article/view/39643 <p>Horizontal gene transfer (HGT) in prokaryotes refers to the movement of genes and genetic information between two organisms. This usually results in the spread of antibiotic resistance genes among bacteria. Vertical gene transfer(VGT), on the other hand, refers to the flow of genetic information from parents to offsprings. Until recently, HGT was an exclusive prerogative of the prokaryotes. These are obvious due to the distinct nuclear membrane enclosure of eukaryote genomes that are shielded from outside interferences. VGT can cross species barriers and may even allow the transmission of genes across the kingdoms of life. HGT is now an emerging idea in eukaryotic genomes, challenging previous assertions that HGT is restricted to prokaryotes. It is now accepted that HGT can profoundly influence host metabolic pathways and alter gene expressions even in eukaryotes. HGT, is also fundamentally important during development, origin of human diseases, such as cancer, and neurodegenerative disorders. It may also influence therapeutic outcome by promoting resistant phenotypes.&nbsp; HGT is recently documented in prokaryote to eukaryote HGT is the tardigrade case though an analysis of a draft tardigrade genome suggested that HGT contributed to up to ~17&nbsp;% of the gene. Further analysis performed after whole genome pair-wise alignments between human genome as well as 53 vertebrate genomes, it was observed that nearly 1500 human genome regions involving 642 known genes, most of which are enriched with ion binding to be conserved with non-mammals than with most mammals. This indicated horizontal gene transfer is more common than we expected in the human genome.</p> <p>It’s a matter of time or maybe a tip of iceberg to know the full extent and implications of HGT. Surprisingly its seems that the eukaryotic genome has many more ways to update itself to vastly expand its repertoire of expression and usability. HGT is just another feather in the crown.</p> Ruby Dhar Arun Kumar Subhradip Karmakar Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 1 2 10.3126/ajms.v12i10.39643 Vaginal Vibrator as an alternative to Dilator in vaginal stenosis post pelvic radiotherapy in cervical cancer https://www.nepjol.info/index.php/AJMS/article/view/37682 <p>Sexuality, post cancer treatment is the most unattended aspect of patient doctor communication. Quality of life in a cancer survivor should be addressed without any inhibitions so that patient does not suffer from any kind of psychological distress. Vaginal stenosis is a well-known side effect of pelvic radiotherapy, which we have tried to address in our study. We have used vaginal vibrator as an alternative to vaginal dilator in two of our patients on experimental basis post vaginal dilator. Both the patients gave feedback that vibrator is comparatively easy to use and less painful. On follow up examination visits, their per vaginal examinations were easy to perform and visibly improved vaginal mucosal health. Psychosexual adjustment is an important domain for better quality of life. Vaginal vibrator is an unorthodox method which we have explored and found some promising results, in overcoming vaginal stenosis and adhesions post pelvic radiation. However, this aspect of treatment as well as method needs to explored.</p> Manjari Shah Disha Tiwari Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 171 174 10.3126/ajms.v12i10.37682 Bilateral abducens palsy in closed head injury: A comprehensive review of literature based on a case report https://www.nepjol.info/index.php/AJMS/article/view/38006 <p>Isolated bilateral sixth nerve palsies are rare, particularly in the setting of trauma. Most post-head injury cases with bilateral abducens palsy involve either basal skull fractures, particularly clival fractures. We present a case of bilateral abducens palsy after closed head injury in a young male who presented to the emergency department and a comprehensive literature review based on our clinical case. A Medline search for bilateral abducens palsy in closed head injury showed 89 results. Articles were excluded if crush head injury, non-traumatic bilateral abducens nerve palsy, associated vascular malformations were reported. After thorough search and filtering of those articles, fifty-one publications were found which reported and discussed about traumatic bilateral abducens palsy with closed head injury. In these 51 articles, a total of 139 cases were recorded. Several theories have been postulated to explain mechanisms of abducens nerve injury in trauma both in immediate and delayed settings. In our case, patient presented with immediate onset of bilateral abducens palsy. On imaging, clival fracture was seen in CT brain, which can be attributed for the nerve injury. Cases with retroclival extradural haematoma had higher chances of multiple cranial nerve injuries. Cases with multiple basal skull fracture involving petrous temporal bone fracture had higher chances of facial nerve injury. Along with bilateral involvement, the poorer outcome for recovery can be related with the severity of the adduction deficit. Our case showed no improvement in bilateral abduction during follow-up at 6 months. Clinical presentation of traumatic bilateral abducens nerve palsy is rare following closed head trauma and is usually associated with other injuries which are incompatible with life. It can be associated with other nerve injuries depending on basal skull fractures.</p> Sandeep B V Rekha K R Manpreet Singh Banga Anantha Kishan Vittal I Nayak Sneha Priya Prabhakar Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 164 170 10.3126/ajms.v12i10.38006 Prevalence of Candida infection in Covid-19 pandemic: A study from a tertiary care center in Central India https://www.nepjol.info/index.php/AJMS/article/view/38528 <p><strong>Background:</strong> Corona virus disease 2019 (COVID-19) infections may be associated with a wide range of bacterial and fungal co-infections. Candida and mucor are the common fungus encountered during this pandemic. Candida is one of the commonly encountered opportunistic fungi that cause superficial mucosal infections usually, but can invade tissue and produce life threatening infections. Candida species recognized as one of the major agent of hospital Acquired (nosocomial) fungal infections. Keeping this in background the current study was conducted.</p> <p><strong>Aims and Objective:</strong> To estimate the prevalence of candida infection in tertiary care hospital of Indore.</p> <p><strong>Materials and Methods:</strong> The present study was done in the period of one and half year. During this period all received clinical specimens like urine, sputum; high vaginal swab and pus suspected for fungal infection from Covid as well as non-Covid patients were processed according to standard protocol. The specimen was subjected to preliminary tests like wet mount, Gram’s stain, culture on sabourads dextrose agar (SDA) and Hichrome agar, germ tube test, sugar assimilation test and culture on Cornmeal agar (dalmau technique) for candida species were done. For statistical analysis Chi-square test was performed and p ≤ 0.05 was considered statistically significant.</p> <p><strong>Results:</strong> The prevalence of Candidiasis was 0.86%. Non-albicans candida (65.9%) isolates was more than Candida albicans (34.07%). Among non-albicans species, C. tropicalis was 27.4% followed by C. glabrata 16.29%, C. krusei 15.55%,C. parapsilosis 5.92% and C. lusitenia 0.74% were the major isolates. Males were affected more than the females. In both the genders maximum patients were from the age group of &gt;60 years. Maximum number of Candida isolates was from blood followed by urine, pus, sputum, vaginal swab and aural swab. Most common risk factors for candidiasis noted in this study was diabetes mellitus in both Covid as well as non-Covid patients.</p> <p><strong>Conclusion:</strong> Non albicans candida are gradually increasing in India. Speciation of candida play an important role in preliminary treatment because different species is intrinsically resistant to different antifungal drugs and have different antifungal susceptibility pattern.</p> Saurabh Jayant Kamlesh Patel Prachi Priya Abhilasha Niti Verma Bharat Singh Ranjana Dahariya Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 3 7 10.3126/ajms.v12i10.38528 An application of the geometric distribution for assessing the risk of infection with SARS-CoV-2 by location https://www.nepjol.info/index.php/AJMS/article/view/38783 <p><strong>Background:</strong> COVID-19 disease has quickly become a pandemic because of high infectiousness among populations. In order to assess for infectiousness reproduction numbers have been widely used in existing literature. A recent research has estimated reproduction numbers by location in order to account for differences among infectiousness.</p> <p><strong>Aims and Objective:</strong> The aim of the present work was to use reproduction numbers in order to obtain an estimate for the mean number of contacts of some patient up to the first transmission of the disease to some other person in a specific location. The objective is to help authorities collect even more information on disease transmission.</p> <p><strong>Materials and Methods:</strong> Our study was based on results obtained in a recent research work where replicated values of reproduction numbers have been generated in order to estimate medians and 95% confidence intervals for these numbers and thus assess infectiousness. We proposed a method that relies on a geometric distribution such that the parameter for this distribution is related to these reproduction numbers.</p> <p><strong>Results:</strong> Our method showed that large reproduction numbers were associated with small mean numbers of contacts up to first transmission of the disease whereas small reproduction numbers were associated with a large mean number of contacts up to first transmission of the disease for all the locations under investigation.</p> <p><strong>Conclusion:</strong> Our method has shown a nice performance and thus it can be considered as an alternative tool, by comparison with reproduction numbers, for assessing the risk of disease transmission, which is particularly useful when locations are investigated separately.</p> Athanase Polymenis Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 8 11 10.3126/ajms.v12i10.38783 Impact of COVID-19 pandemic on psychological health and quality of sleep: An online survey from Kolkata https://www.nepjol.info/index.php/AJMS/article/view/38024 <p><strong>Background:</strong> As a preventive measure to combat COVID-19 pandemic, India has undergone “lockdown” since March 25, 2020. The pandemic and lockdown can impose a psychological impact in the form of fear, anxiety, stress and insomnia etc.</p> <p><strong>Aims and Objective:</strong> The aim of the current study is to assess the magnitude of anxiety, depression, stress and poor sleep quality among the adult population of Kolkata, West Bengal amidst COVID-19 pandemic.</p> <p><strong>Materials and Methods:</strong> By this online survey using Google forms, a total of 435 responses were received. The online questionnaire comprises of Socio-demographic characteristics, COVID—19 Anxiety Scale (CAS), Perceived Stress Scale 4 (PSS 4), Patient Health Questionnaire-9 (PHQ 9) and Insomnia Severity Index (ISI).</p> <p><strong>Results:</strong> COVID-19 related anxiety were almost similar across age groups, sex, marital and educational status. PSS score was found higher in ≤25 years and &gt;40 years age group, those not currently married, students and homemakers. Patient Health Questionnaire scores were found significantly different across all background characteristics categories except for the level of education whereas Insomnia Severity index Scale scores were found significantly more among subjects not currently married and among subjects who were working from home.</p> <p><strong>Conclusions:</strong> The current study provides evidence towards the negative psychological impact of the pandemic and reminds us about the need for widespread psychiatric services during and after pandemic.</p> Arijit Mondal Indranil Saha Niladri Banerjee Pradeep Kumar Saha Soumi Ghosh Dwaipayan Saha Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 12 19 10.3126/ajms.v12i10.38024 Analysis of second wave of COVID-19 cases in Nepal with a logistic model https://www.nepjol.info/index.php/AJMS/article/view/38763 <p><strong>Background:</strong> COVID-19, caused by SARS-CoV-2, is a newly identified highly infectious disease. It has affected almost every country including Nepal causing a pandemic situation. Most of the properties of SARS-CoV-2 are not known and still under intense investigation. Due to high mutation rate, it reappears in many countries in the form of new variant. In Nepal, second wave impact of COVID-19 is mainly caused by newly found delta variant of SARS-CoV-2. In this case, the mathematical modelling is noted to play important role to understand control strategies for the spread of coronavirus.</p> <p><strong>Aims and Objective:</strong> To analyze the second wave impact by modelling the data of COVID-19 cases in Nepal.</p> <p><strong>Materials and Methods:</strong> We have analyzed COVID-19 daily cases and deaths reported by Ministry of Health and Population, Government of Nepal from April 1 to May 31, 2021. A logistic model has been used to present the trend line of COVID-19 infection in Nepal, based on the law of population growth developed by Verhulst.</p> <p><strong>Results:</strong> The results show a good fit between observed and predicted data by logistic model as indicated by coefficient of determination having value near to unity. The point of inflection from the logistic model predicted a maximum of 9951 daily new cases. The maximum number of cumulative cases estimated at the end of second wave was found to be 307293 with 95% confidence interval.</p> <p><strong>Conclusion:</strong> Logistic model properly describes the growth of COVID-19 cases with time. This type of data modelling and analysis will be very useful in predicting the upcoming trend of COVID-19 in Nepal as a basis for making health policy management by the government.</p> Radha Krishna Joshi Sarita Bhatt Tika Ram Lamichhane Madhav Prasad Ghimire Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 20 26 10.3126/ajms.v12i10.38763 Effect of Covid-19 pandemic induced lockdown on sleep wake pattern and personal well-being of undergraduate medical students of West Bengal https://www.nepjol.info/index.php/AJMS/article/view/38354 <p><strong>Background:</strong> COVID-19 pandemic induced lockdown and the social restrictions had a profound impact on the circadian rhythm driven sleep-wake schedule of the home confined population.</p> <p><strong>Aims and Objective:</strong> Our study explored the effect of COVID-19 pandemic induced lockdown on sleep wake pattern and personal well-being of medical students of West Bengal</p> <p><strong>Materials and Methods:</strong> An observational, questionnaire-based online survey was conducted using the URL linked Google form. The online survey was conducted through social media platforms as per CHERRIES checklist guideline. Information on demographic profile, before and after lockdown sleep-wake pattern, social wellbeing and general lifestyle was obtained. Any student with any sleeping disorder or on drugs was excluded. Mean (SE), median, range, proportion was calculated as per attributes. Fisher’s exact chi square test and paired t test was done to test association and to compare means of the attributes.</p> <p><strong>Results:</strong> The mean age of students was 20.26 years. The average daily time spent on electronic media got doubled during lockdown. Sleep disorder was reported by 53.0% male and 47.0% students. More than half of respondents reported increased napping during daytime, irregular timing for meal intake and low mood. Anxiety was present in every two out of three participants. Females gained more weight during lockdown. The gender difference in sleep duration became significant. Lockdown effect on the average daily media time was significant. The sleep disturbance at night and physical inactivity was significantly more among female students.</p> <p><strong>Conclusion:</strong> COVID-19 lockdown leads to delayed sleep-wake cycle, irregular meal timings and excessive digital exposure among medical students with gender based differential impact.</p> Sujata Biswas Bhaskar Saha Indranil Halder Gandhari Basu Anupam Ghosh Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 27 33 10.3126/ajms.v12i10.38354 Japanese encephalitis in children from an endemic district of West Bengal, India: A hospital based observational study https://www.nepjol.info/index.php/AJMS/article/view/37395 <p><strong>Background:</strong> Japanese encephalitis (JE) is an important cause of viral encephalitis in children in South East Asian countries including India.</p> <p><strong>Aims and Objective:</strong> We have done this study in an JE endemic district of India to know the demographic profile, clinical presentation, seasonal variation, outcome and about the vaccination status of the JE cases.</p> <p><strong>Materials and Methods:</strong> This observational, cross sectional study was done for a period of one year in the Pediatric department of Burdwan Medical College, West Bengal in children up to the age of 12 year, presented with acute encephalitis syndrome (AES). Demographic data, clinical presentation and JE vaccination status were recorded and confirmed JE cases were detected by either serum or CSF JE IgM antibody. Outcome of the JE cases were noted as discharge, death or leave against medical advice (LAMA).</p> <p><strong>Results:</strong> We have found confirmed JE in 18 children out of total 125 AES cases (14.4%). 61.1% of them were within 6 to 12 year age, mostly from low socioeconomic status and 100% case occurred during monsoon and post monsoon period. History, was of JE vaccination were present in only 11.1% case of JE. Most common presenting symptoms were high fever (100%), convulsion (94.4%) and altered sensorium (72.2%). 77.8% JE case were discharged and 11.1% expired.</p> <p><strong>Conclusion:</strong> We must consider JE whenever a child from any endemic district comes with AES and we should try to bring every child under the JE vaccination coverage in the endemic regions globally to reduce the burden of this preventable encephalitis.</p> Abhishek Gupta Sumanta Laha Kanai Lal Barik Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 34 38 10.3126/ajms.v12i10.37395 Prospective analysis of risk factors and angiographic profile in women with coronary artery disease –A hospital based study https://www.nepjol.info/index.php/AJMS/article/view/38403 <p><strong>Background:</strong> In order to facilitate diagnosis and timely intervention, it is essential to understand the presentation pattern of cardiac symptoms, and distribution of risk factors in women with Coronary Artery Disease (CAD). However, limited data is available regarding the salient features of CAD in women like distribution of risk factors and anatomical extent.</p> <p><strong>Aims and Objective:</strong> The purpose of the present study was to determine the clinical and risk factor profile of women admitted with CAD and to analyze their angiographic findings in relation to the clinical presentation and risk factors in a tertiary care referral center of eastern India.</p> <p><strong>Materials and Methods:</strong> In this study we prospectively analysed risk factors and angiographic patterns of 140 consecutive female patients who underwent coronary angiography for suspected CAD over a period of 2 years.</p> <p><strong>Results:</strong> CAD most commonly affected females of age group &gt;60yrs with higher incidence among postmenopausal as compared to premenopausal women. Unstable angina was the commonest presentation among patients with normal coronaries as well as obstructive CAD.A substantial percentage of women presenting with anginal pain were angiographically normal. Hypertension was the most common associated risk factor followed by diabetes, elevated total cholesterol, high LDL &amp; low HDL. Most common coronary angiography finding was single vessel disease. On analysis, diabetes mellitus, elevated cholesterol, elevated LDL &amp; triglycerides were most commonly associated with triple vessel disease.</p> <p><strong>Conclusion:</strong> The incidence of CAD in females increased with age. Single vessel disease was the commonest presentation with Left Anterior Descending Artery, the most frequently involved vessel.</p> Subhasish Singh Rashmita Pradhan Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 39 46 10.3126/ajms.v12i10.38403 Thyroid dysfunction in patients of metabolic syndrome: A study from a tertiary care center in India https://www.nepjol.info/index.php/AJMS/article/view/38313 <p><strong>Background:</strong> Metabolic syndrome is characterized by hypertension, dyslipidemia, central obesity, glucose intolerance, insulin resistance. Thyroid hormone acts as general pacemaker, accelerating metabolic process and may be associated with metabolic syndrome. There is no information available in literature regarding the prevalence and association of thyroid dysfunction in metabolic syndrome in this central region of the country.</p> <p><strong>Aims and Objective:</strong> To estimate the prevalence of thyroid dysfunction in patients of metabolic syndrome.</p> <p><strong>Materials and Methods:</strong> It is a duration based prospective cross sectional study including 200 patients of metabolic syndrome. A detailed history, clinical examination and relevant investigations including serum Free T4 (FT4), Free T3 (FT3), Thyroid Stimulating Hormone (TSH) were done. Range, frequencies, percentage, mean, standard deviation and P value were calculated. P value of &lt; 0.05 was taken as significant.</p> <p><strong>Results:</strong> Prevalence of thyroid dysfunction in metabolic syndrome patients was 28.5%. Prevalence of subclinical and overt hypothyroidism was 18.5% and 8.5% respectively. In patients with both metabolic syndrome and thyroid dysfunction, most common components associated are diabetes mellitus and hypertriglyceridemia.</p> <p><strong>Conclusion:</strong> Thyroid dysfunction is significantly common in metabolic syndrome patients. It should be aggressively detected and treated in these patients for better outcome.</p> Ritu Gupta Akhil K Vijayan Sushma Choudhary Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 47 50 10.3126/ajms.v12i10.38313 Profile and early prediction of neuromotor outcome of very low birth weight infants https://www.nepjol.info/index.php/AJMS/article/view/38475 <p><strong>Background:</strong> Very low birth weight infants are at increased risk of developmental disorder. Early identification is necessary for planning and implementation of early intervention.</p> <p><strong>Aims and Objective:</strong> To test the association of neurological examination at 40 weeks and 3 months with neuro motor outcome of VLBW infants at 24 months and to identify the perinatal and neonatal risk factors for atypical neurological outcome.</p> <p><strong>Materials and Methods:</strong> It is a prospective cohort study. Consecutive 120 VLBW infants were enrolled in a single centre level III neonatal unit of a teaching hospital. Neuro motor assessment was done by Dubowitz neurological examination at 40 weeks and by Hammersmith infant neurological examination (HINE) at 3 months and 12 months at neurodevelopmental clinic. Motor assessment were performed by Alberta Infant Motor Scale (AIMS) at 6 and 12 months and by Bayley Scale of Infant &amp; Toddler scale, (BSID) 3rd edition at 6,12 and 24 months respectively. All assessment ages were corrected for prematurity.</p> <p><strong>Results:</strong> At 12 months 4.5% infants developed abnormal tone and 5.6% had motor delay. Four infants developed cerebral palsy at 24 months. Shock in neonatal period had significant association with suboptimal motor outcome at 12 months. Suboptimal HINE score at 12 months was rightly predicted at 3 months by HINE.</p> <p><strong>Conclusion:</strong> Early anticipation and early identification of abnormal neuro motor outcome of VLBW infants can be used as simple and cost-effective measures for preventing long term neuro motor morbidity at resource limited countries.</p> Saugata Chaudhuri Suchandra Mukherjee Tanmoy Kumar Bose Turna Roy Chowdhury Kaushik Jana Debarshi Jana Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 51 57 10.3126/ajms.v12i10.38475 Effect of intermittent normobaric hypoxia exposure on acclimatization to high altitude by air induction https://www.nepjol.info/index.php/AJMS/article/view/38266 <p><strong>Background:</strong> In emergency like condition, defence personnel are deployed to high altitude without proper acclimatization. Maladaption at high altitude leads to high altitude illness like acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE) which hampers the operational capabilities.</p> <p><strong>Aims and Objectives:</strong> The aim of the present study was to assess the effect of intermittent normobaric hypoxia exposure (IHE) at sea level on different physiological responses during initial days of acclimatization at 3500m and 4000m altitudes in acute induction.</p> <p><strong>Materials and Methods:</strong> The IHE subjects were exposed to 12% FIO2 (equivalent altitude 14500 ft) for 4 hrs/day for 4 consecutive days at sea level and 5th day they were inducted by air to 3500m altitude. Baseline recording of different physiological parameters like cardiovascular, respiratory, oxygen saturation and AMS score were measured at sea level as well as 3500m altitude on daily basis for 6 days to assess acclimatization status. To confirm acclimatization status at 3500m, on fifth day the IHE group subjects were transported by road to 4000m and again measured different basal physiological parameters (like cardiovascular, oxygen saturation and AMS score) for four consecutive days.</p> <p><strong>Results:</strong> Different physiological parameters of IHE treated group were stabilized by day 4 of air induction at 3500m altitude. Whereas, at 4000m altitude, these parameters were stabilized by day 2 of induction.</p> <p><strong>Conclusion:</strong> Acclimatization schedules of four days at 3500m and two days at 4000m are essential to avoid malacclimatization/or high-altitude illness.</p> Gopinath Bhaumik Deepak Dass Dishari Ghosh Kishan Singh Maram Prasanna Kumar Reddy Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 58 63 10.3126/ajms.v12i10.38266 Pulmonary function test correlation with subclinical respiratory dysfunction in chronic cervical cord compression https://www.nepjol.info/index.php/AJMS/article/view/37705 <p><strong>Background:</strong> To assess respiratory function in cervical chronic compressive myelopathy (CCM) patients in pre-operative period, post-operative period and to compare pre-operative status with post-operative status.</p> <p><strong>Aims and Objectives:</strong> 1. To assess respiratory function in cervical CCM patients in pre-operative period. 2. To assess respiratory function in cervical CCM patients in post-operative period, following relief of compression. 3. To compare, pre-operative status with post-operative status.</p> <p><strong>Materials and Methods:</strong> A prospective study was done in 50 patients with cervical CCM due to either cervical disc disease or ossified posterior longitudinal ligament (OPLL) who were operated. None of the patients included in the study had any clinical signs &amp; symptoms of respiratory dysfunction. Spirometry was performed in pre-operative and postoperative period after 3 months and results were analyzed. Forced vital capacity (FVC), forced expiratory volume in first second (FEV1), ratio of mean FEV1 to FVC (FEVI: FVC%) and peak expiratory flow rate (PEFR) were calculated.</p> <p><strong>Results:</strong> Majority of the patients were in their fourth decade of life with male predominance. Thirty-six patients (72%) presented with prolapsed intervertebral disc and 14 patients (28%) had ossified posterior longitudinal ligament (OPLL). Patients were operated depending upon the pathology. The present study showed that there was significant reduction in preoperative FVC, FEV1, PEFR values as compared with predicted values and they showed significant improvement in post-operative period after surgical relief of compression.</p> <p><strong>Conclusion:</strong> Significant yet occult respiratory dysfunction in form of impairment of various lung capacities exists in patients with cervical CCM. An objective evaluation of this occult respiratory dysfunction is essential to prognosticate, prevent respiratory complications and to improve post-operative respiratory rehabilitation. Institution of incentive spirometry as a routine in all cervical CCM cases will be of benefit in preventing respiratory complications.</p> Manpreet Singh Banga Sandeep BV Anantha Kishan Rajesh Babu Devabhakthuni Arun MA Arjun H Dev Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 64 68 10.3126/ajms.v12i10.37705 An observational study on pattern of mortalities as per ICD-10 classification system in a tertiary care hospital in India https://www.nepjol.info/index.php/AJMS/article/view/37781 <p><strong>Background:</strong> Records of vital events like death constitute an important component of the Health Information System. Patterns of mortality decline that occur with the demographic transition is a change in the distribution of deaths by cause away from a pattern dominated by communicable diseases toward one in which non-communicable diseases account for the overwhelming majority of deaths.</p> <p><strong>Aims and Objective:</strong> To identify the mortality pattern in Burdwan Medical College as per ICD-10 classification in the year 2017.The study also evaluated socio-demographic distribution and causes of deaths during that period.</p> <p><strong>Materials and Methods:</strong> It was an Institution based retrospective observational study. Complete enumeration of all hospital records of medically certified deaths of in-patients from different departments except the Paediatrics who died in 2017 was done. The underlying cause of death was classified according to I.C.D 10th revision, version 16. Information collected included also the demographic characteristics like age, gender, date of admission, place of residence and date of death for the study.</p> <p><strong>Results:</strong> In this study, most of the deaths were seen in males (59.99%), with a sex ratio of female to male deaths to be 667 per thousand. The major proportion of deaths was in the age group of 55 to 64 years (23.53%). The percentage distribution of ten major cause groups of death for the period from January to December during 2017 reveals that the group “Diseases of the Circulatory System” had occupied the position of the top-most killer and it had maintained the trend throughout the year with the highest rate in the month of March (43.9%). The cause of death was more in Non-Communicable diseases (Chapter IX, Chapter XIX) compared to that of Communicable diseases.</p> <p><strong>Conclusion:</strong> Procedures for death certification and coding of underlying causes of death need to be streamlined to improve reliability of registration data needed for epidemiological research or public health policy formulation.</p> Chinmay Nandi Kaushik Mitra Dipankar Bhaumik Shamik Parna Paul Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 69 74 10.3126/ajms.v12i10.37781 CD10 expression in gastric adenocarcinoma and its correlation with histopathological features and lymph node metastasis https://www.nepjol.info/index.php/AJMS/article/view/38754 <p><strong>Background:</strong> Gastric cancer is one of the most common cancers worldwide. Invasion and metastasis are known prognostic factors. Previous studies have suggested CD10 expression in the epithelium and stroma of various carcinomas is associated with more aggressive behavior of the tumor.</p> <p><strong>Aims and Objective:</strong> To study the immunohistochemical expression of CD10 in stromal cells of gastric adenocarcinoma and to correlate the expression with various clinicopathological features and lymph node metastasis.</p> <p><strong>Materials and Methods:</strong> A cross sectional study of CD10 expression in 40 cases of gastric carcinoma in gastrectomy specimens was done. CD10 expression was correlated with age, gender, tumor site, tumor grade, histologic sub type, depth of invasion and lymph node status.</p> <p><strong>Results:</strong> Out of 40 cases, 72.5% were males and 27.5% were females. Majority of cases were seen in 6th and 7th decades. Antrum was the most common location (70%) and intestinal morphology was the commonest histologic subtype (47.5%). Tumor size ranged from 2.5 to 11cms. 40% tumors were well differentiated. Majority (62.5%) of the tumors were in T3 stage. 25 (62.5%) cases showed a positive CD10 expression in stromal cells. Stromal CD10 expression in gastric carcinoma did not correlate with the age and gender of the cases as well as the location and size of the tumor, histologic subtype and lymph node involvement but correlated with depth of invasion (T stage) (p &lt;0.05).</p> <p><strong>Conclusion:</strong> CD10 expression in gastric adenocarcinoma shows a significant correlation with depth of invasion. CD10 may be used as an immunohistochemical surrogate of tumor behavior.</p> Bhavya Pappalamukalel Mohan Sharath Kesavan Krishnan Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 75 80 10.3126/ajms.v12i10.38754 Indices in differentiating iron deficiency anemia from thalassemia trait- a comparative study https://www.nepjol.info/index.php/AJMS/article/view/38268 <p><strong>Background:</strong> Iron deficiency anemia (IDA) and beta thalassemia trait (BTT) are the two most common and important causes of microcytic hypochromic anemia in India. It is very difficult to differentiate between the two. Many different types of techniques have been proposed for the same. While some are invasive like bone marrow examination others are not available at all centers, like electrophoresis. Hence different indices come into play.</p> <p><strong>Aims and Objective:</strong> This study was undertaken to compare the efficacy of Shine and Lal index and Mentzer index in differentiating between IDA and BTT.</p> <p><strong>Materials and Methods:</strong> A total of 407 anemia cases were studied over a period of 18 months and their blood samples were subject to different hematological and biochemical assays to diagnose the type of anemia.</p> <p><strong>Results:</strong> Based on these tests 92.1% cases were found to be of IDA whereas 3.7% cases were found to be of BTT. Then both the indices were applied in the above mentioned cases.</p> <p><strong>Conclusion:</strong> While Shine and Lal index was found to have better sensitivity, Mentzer index was found to have better specificity.</p> Sufia Ahmad Noorin Zaidi Syed Riaz Mehdi Sumaiya Irfan Sharique Ahmad Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 81 86 10.3126/ajms.v12i10.38268 Esophageal Motility Disorders in patients with Gastro-Esophageal Reflux Disease diagnosed by using High Resolution Esophageal Manometry- data from the developing world https://www.nepjol.info/index.php/AJMS/article/view/38225 <p><strong>Background:</strong> Gastro-esophageal reflux disease (GERD) has a prevalence of 10-20% in the Western countries while its prevalence amongst the Pakistani population is between 22 to 24%. Esophageal manometry is currently the gold standard for diagnosing esophageal motility disorders.</p> <p><strong>Aims and Objectives:</strong> To determine the frequency of esophageal motility disorder in patients with GERD.</p> <p><strong>Materials and Methods:</strong> This cross-sectional study was conducted at the department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan. Patients diagnosed with GERD (defined as having typical reflux symptoms with more than 2 episodes per were) were included in this study. These patients were subjected to upper GI endoscopy followed by esophageal manometry. Esophageal motility disorders were then classificated by using the Chicago classification 3.0.</p> <p><strong>Results:</strong> A total of 76 patients were included in our study, out of which 41 (53.9%) were females. A mean age of 46.1 years ± 12 years and a mean body mass index (BMI) of 23.7kg/m2 was noted. The most common comorbid condition seen in our patients was diabetes mellitus, which was seen in 13 patients (17%). A normal EGD was noted in 48 patients (63%). Liquid perfusion esophageal manometer catheter was mainly used in our study that is in 70 patients (92.1%). Weak esophageal peristalsis was the most common esophageal motor abnormality seen in 16 patients (21.1%).</p> <p><strong>Conclusion:</strong> A significant proportion of patients with GERD have the presence of a motility disorders, the early identification and treatment of which can lead to improvement GERD symptoms.</p> Zain Majid Syed Mudassir Laeeq Muhammad Manzoor ul haq Farina M Hanif Shoaib Ahmed Khan Abbas Ali Tasneem Nasir Hassan Luck Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 87 91 10.3126/ajms.v12i10.38225 Study of clinical profile of dermatophytosis in a tertiary care center as per ECTODERM guidelines https://www.nepjol.info/index.php/AJMS/article/view/37653 <p><strong>Background:</strong> Dermatophytic infections are one of the most common skin infections encountered by dermatologists. A recent increase in incidence has been seen over the last few years with substantial change in the clinical profile of patients. Recently a group of dermatology experts published Expert Consensus on The Management of Dermatophytosis in India (ECTODERM India). The group agreed upon various definitions with respect to current dermatophytosis epidemic as well as gave recommendations for investigations and management. Clinical profile of dermatophytosis was done in present study on the basis of definitions agreed upon by ECTODERM consensus group.</p> <p><strong>Aims and Objective:</strong> To assess the clinical profile, prevalence and severity of dermatophytic infection in study population.</p> <p><strong>Materials and Methods:</strong> Cross-sectional observational study was conducted at out-patient department of Dermatology in, Sharda hospital, Greater Noida. A total of 317 patients presenting with clinical diagnosis of dermatophytosis were included in the study.</p> <p><strong>Results:</strong> A total of 317 patients were recruited in the study, out of which 213 were males (67.2%). The most common age group presenting with superficial dermatophytosis was 21-30 years. Majority of the patient presented with chronic dermatophytosis with duration more than 6 months (76.6%) while more than 3 lesions of tinea were observed in 76.6% cases. 191 patients (60%) had moderate to severe involvement with more than 3% of BSA involved. Family members presenting with similar complaints were seen in 39% cases. Majority of patients (76 %) studies had received previous treatment topical, systemic or both. 62 patients presented with recurrence of disease within 6 weeks of complete antifungal treatment (19.6%).</p> <p><strong>Conclusion:</strong> Our study concludes that dermatophytosis still remain a challenging issue for dermatologists. Chronicity of infection, moderate to severe BSA involvement and involvement of family members in a good proportion of our study cases were the main findings of our study.</p> Shitij Goel Shivam Dr Azra Ferheen Chaudhary Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 92 96 10.3126/ajms.v12i10.37653 Clinical effects of two different doses of duloxetine compared to conventional analgesic therapy in patients with osteoarthritis knee https://www.nepjol.info/index.php/AJMS/article/view/37479 <p><strong>Background:</strong> Pain is the leading symptom of knee osteoarthritis (OA) leading to significant morbidity and decreased quality of life. Duloxetine, a selective serotonin norepinephrine reuptake inhibitor, has been demonstrated to have a centrally acting analgesic effect.</p> <p><strong>Aims and Objectives:</strong> To evaluate the efficacy and safety of two different doses of duloxetine and compare with conventional pharmacotherapy in treatment of chronic pain due to osteoarthritis of knee.</p> <p><strong>Materials and Methods:</strong> 90 patients with symptomatic knee OA were randomly divided into 3 groups to receive duloxetine 40 mg &amp; 3g paracetamol/day (Group A), duloxetine 20 mg &amp; 3g paracetamol/day (Group B) and paracetamol 3gm/day (Group C). Patients were followed up for 6 months to assess pain relief and functional improvement. Visual Analogue Scale (VAS) for assessing pain intensity and Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire physical function subscale for assessing physical function were used.</p> <p><strong>Results:</strong> Reduction in VAS score from baseline was significantly high in groups A and B as compared to C at 1 month, 3 months and 6 months. Reduction in WOMAC score from baseline were also significantly high in groups A and B as compared to C at 1 month, 3 month and 6 months. Adverse effects in Group A were significantly high as compared to group B and C. Patients discontinuing due to adverse effects were significantly high in group A.</p> <p><strong>Conclusion:</strong> Lower dose of duloxetine is associated with significant pain reduction and improved function with lesser adverse effects in patients with pain due to knee OA.</p> Arpita Choudhury Dipasri Bhattacharya Rajasree Biswas Swati Saroha Nitisha Chakraborty Samrat Roy Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 97 104 10.3126/ajms.v12i10.37479 Is Saddle block superior to spinal anaesthesia for patients undergoing transurethral resection of prostate- a comparative evaluation https://www.nepjol.info/index.php/AJMS/article/view/38300 <p><strong>Background:</strong> TURP is the most common surgical intervention for patients with benign prostatic hyperplasia.</p> <p><strong>Aims and Objectives:</strong> This prospective randomized study was planned to evaluate spinal anaesthesia (SA) versus saddle block with regard to haemodynamic parameters, ephedrine consumption, patient and surgeon satisfaction, perioperative complications in patients undergoing TURP.</p> <p><strong>Materials and Methods:</strong> Eighty patients between the ages of 50-80 years with BPH, belonging to ASA grade I- III, prostatic volume between 50 - 80 cc were included in our study. Patients were randomly divided into two groups of 40 patients each. Patients in group SA (n=40) received spinal anaesthesia and the patients in group SBBI (n=40) were given saddle block with bladder instillation of local anaesthetic jelly for undergoing TURP.</p> <p><strong>Results:</strong> There was more statistically significant fall in MAP in Group SA as compared to Group SBBI (p&lt;0.05). Complications like hypotension, bradycardia and vasopressor requirement was less but requirement (p=0.021) of supplemental analgesia was more in patients who were administered saddle block. There was significantly lower patient satisfaction in saddle block (p=0.044) but comparable surgical satisfaction in both groups.</p> <p><strong>Conclusion:</strong> Both Spinal anaesthesia and saddle block are safe and effective techniques of anaesthesia for patients undergoing TURP. SA has advantages like less requirement of supplemental analgesia, longer duration of post-operative analgesia and more patient satisfaction. However, saddle block is superior to spinal anaesthesia with regard to haemodynamic stability; with less chances of hypotension, bradycardia and less vasopressor requirement. It is similar to SA in terms of providing adequate surgical conditions.</p> Kirti Kshetrapal Priyanka Mishra Hemant Kamal Priyanka Bansal Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 105 110 10.3126/ajms.v12i10.38300 Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for lower calyx renal stones https://www.nepjol.info/index.php/AJMS/article/view/37949 <p><strong>Background:</strong> Due to the anatomic characteristics of the lower calyx, lower polar stones are difficult to be removed through the ureter, retrograde intrarenal surgery (RIRS) can be used to deal with lower polar stones, while mini-percutaneous nephrolithotomy(mini-PCNL) is mainly used to deal RIRS failed to eliminate the stone.</p> <p><strong>Aims and Objectives:</strong> Prospective comparison of mini-PCNL and retrograde intrarenal surgery outcomes in lower calyx management<br />with respect to surgery duration, pain score (visual analog score), analgesic requirement, hemoglobin drop, and hospital stay.</p> <p><strong>Materials and Methods:</strong> This is a prospective study in 50 patients (25 cases of RIRS and 25 cases of MINIPERC) over 2 years who came to the urology departme with lower calyx stone of size up to 20mm. The selection of the management methods was primarily based on the patient’s preferences. Preoperatively, all patients underwent routine workup and CT KUB plain. The primary and secondary objective was stone clearance rates, retreatment rate, complications, surgical duration, pain score (visual analog score [VAS]), analgesic requirement, hemoglobin drop, and hospital stay.</p> <p><strong>Results:</strong> Miniperc and RIRS had stone clearance rates of 100% and 96%, respectively. In the RIRS group, one patient required retreatment for 1month. Hospital stay, intraoperative and post-operative complications were non-significant between both groups. Operative duration (P=0.003) was lower in the Miniperc group. Hemoglobin drop (P&lt;0.0013), patient pain, and visual analog scale score at 6, 24, and 48 h, as well as an analgesic requirement (P&lt;0.020), were all lower in the RIRS group.</p> <p><strong>Conclusion:</strong> The stone clearance rates in both modalities are high, and complications are low. RIRS requires a longer operative duration, and it is associated with favorable pain scores and a lower hemoglobin drop.</p> Ershad Hussain Galeti Saqib Shahab Mriganka Deuri Bharali Rajaboina Yakaiah Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 111 116 10.3126/ajms.v12i10.37949 Clinicopathological profile of paediatric vitellointestinal duct anomalies https://www.nepjol.info/index.php/AJMS/article/view/38233 <p><strong>Background:</strong> Vitellointestinal duct (VID) or Omphalomesenteric duct (OMD) is the embryonic connection between the yolk sac and the primitive midgut. Anomalies result from failure of the involution of the VID. Normally, it obliterates between the fifth and seventh weeks of fetal life. They include Meckel’s diverticulum (MD), fibrous band, fistula, sinus tract, cyst, and umbilical polyp. Symptomatic cases require surgical correction. They are characterised by different clinical presentations and histological appearances. This study gathers a single paediatric institutional experience of VID remnants, their demographic, clinical profile, varied histomorphology including the presence of ectopic tissues.</p> <p><strong>Aims and Objectives:</strong> The objective of this study was to retrospectively review all the symptomatic cases of VID abnormalities at a tertiary pediatric referral hospital. The demographic profile, clinical presentation, and histopathology were reviewed and descriptively analyzed. We classified these anomalies based on embryology and histology. The findings of this study will provide insights to pathologists and treating clinicians less exposed to these rare lesions.</p> <p><strong>Materials and Methods:</strong> Data was retrieved retrospectively from the pathology records of a tertiary paediatric referral institute for 3 years. Histological slides of VID anomalies were reviewed and a descriptive analysis of the findings was performed. A thorough review of the literature was also done on these very rare lesions and their findings compared to our results.</p> <p><strong>Results:</strong> A total of 60 cases of VID anomalies were encountered during the study period. There was significant male preponderance. The most common age group at surgery was infancy. MD was the commonest VID anomaly. The least common was vitelline fistula and only a single case was encountered in the study period. Ectopic tissues were seen in 25% of the cases and included gastric and colonic mucosae and pancreatic tissue.</p> <p><strong>Conclusion:</strong> The histopathology of VID anomalies provides an interesting diagnostic experience for the reporting pathologist. Awareness of the embryology, presentation and histology of these lesions aids in accurate diagnosis.</p> Othuluru Hema Radhika Krishna Srinivas Sriampur Gaddam Janardhan Vani Padmaja Ramesh Reddy Kota Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 117 123 10.3126/ajms.v12i10.38233 Ultrasonographic study of comparison of prostate volume and post void residual urine with age in north Indian population https://www.nepjol.info/index.php/AJMS/article/view/37933 <p><strong>Background:</strong> As men’s life expectancy increases, benign prostatic hyperplasia (BPH) is the significant cause of morbidity. BPH generally involves the central region of the prostate which gradually enlarges. Due to the central hypertrophic change of prostate the urethra is compressed and urinary outflow obstruction develops. Predictive risk factors associated with chance of developing urinary retention includes age, symptoms, urinary flow rate and prostate size. Estimation of accurate intravesical, residual urine has significant importance and serves as an index of adequacy of bladder emptying.</p> <p><strong>Aims and Objectives:</strong> The study aimed to measure the post void residual urine volume with age in Prostate outflow obstruction and compare the prostate volume and post void residual urine with age by ultrasonography.</p> <p><strong>Materials and Methods:</strong> The present study was performed in 100 patients. Transrectal ultrasonography was performed using 7.5 MHZ transrectal probe. Prostate volume was calculated with the help of inbuilt software, by measuring 3 dimensions of prostate in transverse and longitudinal sections. Transabdominal suprapubic ultrasound was done to measure post void residual urine.</p> <p><strong>Results: </strong>It was seen that in the lower age groups, the prostate size was smaller, while in the higher age group it was higher (p&gt;0.001). Minimum post void residual urine was seen in age group of 40-49 years (3.42 -+2.23ml). while maximum mean value was seen in the 70-79 years of age. Statistically a significant difference in mean was seen among different age groups (p&lt;0.001).</p> <p><strong>Conclusion:</strong> There is a significant correlation between age and post void residual urine volume and prostatic volume. The present study showed that PVRUV is a novel accurate non-invasive test for predicting prostate biopsy<br />outcome that can easily be used by clinicians, alone or in combination with Prostate Volume in the decision-making for treatment.</p> Tahsin Munsif Syed Shabeeh Haider Vineeta Tewari Mariyam Fatima Pradeep Kumar Sharma Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 124 128 10.3126/ajms.v12i10.37933 Sexual dysfunction in married female patients on antidepressants: A Cross Sectional Observational study from Patna medical college and hospital https://www.nepjol.info/index.php/AJMS/article/view/38883 <p><strong>Background:</strong> Clinicians and patients now have a broad variety of antidepressants to choose from, due to an ever-growing pharmacopoeia. However, one of the most significant considerations preventing antidepressant use is their side effects, one of which is sexual dysfunction. This issue has a negative impact on the patient’s quality of life which can contribute to clinical non-adherence in long-term therapies.</p> <p><strong>Aims and Objectives:</strong> The objective of this research was to look into the characteristics of sexual dysfunction in married female antidepressant patients and patterns of sexual dysfunctions in female patients receiving antidepressants.</p> <p><strong>Materials and Methods:</strong> It was Cross-sectional observational study. The study was conducted in the department of Psychiatry, Patna Medical College and Hospital at Patna.The Departmental Research Committee accepted the report, and 50 patients were enrolled after receiving written informed consent. Purposive sampling was used to pick the sample for the analysis, which had a cross-sectional study. The women contacted were in the outpatient psychiatric care of the department of Psychiatry and had been diagnosed with depressive disorder during the study period June 2018 to February 2019.</p> <p><strong>Results:</strong> Seventy percent of patients were taking selective serotonin reuptake inhibitors (SSRIs), 20 % were taking tricyclic antidepressants (TCAs), and 10 % were taking other medications such as mirtazapine or desvenlafexine. Within six months, 44 % of patients were on therapy, and 22.0 % had been on treatment for more than two years. Patients taking Escitalopram (80 %) have less sexual activity than those taking Sertraline (66.7 %) or Fluoxetine (77.8 %), Patients observed a change in sexual activity in 58 percent of cases, a decrease in sexual desire in 70 % of cases (p=0.0009*), a slight decrease in 14 percent of cases, and a slight decrease in only 8 % of cases (p=0.0009). 18 % of patients reported a delay in orgasm, with 66 percent reporting a major delay, 8 % reporting a moderate delay, and 8 % reporting a slight delay (p=0.0001).</p> <p><strong>Conclusion:</strong> Our findings indicate that sexual dysfunction is common in married female patients taking antidepressants, and that antidepressants affect both aspects of sexual functioning.</p> Vivek Pratap Singh Abhishek Pratap Singh Narendra Pratap Singh Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 129 134 10.3126/ajms.v12i10.38883 Doppler Velocimetry evaluation in high-risk pregnancy for prediction of Preeclampsia https://www.nepjol.info/index.php/AJMS/article/view/38390 <p><strong>Background:</strong> The uterine and umbilical artery Doppler scan is a valuable tool for evaluation of utero-placental blood flow in pregnancy. They help in detecting uteroplacental insufficiency thus predicting preeclampsia and other effects of faulty placentation which increase the risk of adverse effects on both mother and fetus.</p> <p><strong>Aims and Objective:</strong> This study aimed to evaluate and compare the uterine artery and umbilical artery Doppler indices in second and third trimester for prediction of preeclampsia in high-risk pregnancies.</p> <p><strong>Materials and Methods:</strong> In this prospective observational study done over a years’ time, 50 high-risk pregnant mothers were recruited and the Doppler scans were done at 21-25 weeks and 31-35 weeks. The necessary clinical observations were recorded throughout the antenatal period and the data analysis was done.</p> <p><strong>Results:</strong> Majority (56%) were in 20-29 years range with mean age of 24±6.1 years. Out of the 50 women, 21 had abnormal uterine artery Doppler and 12 had umbilical artery abnormality along with uterine derangement. Preeclampsia developed in 3 of them. The hypertensive disorders of pregnancy were diagnosed in 13 women, preeclampsia in 3, eclampsia in 1and other HDPs in 9. The persistence of notch in uterine artery was observed in 7 women, of these 2 developed PIH. Only one patient had uterine artery PI&gt;1.45 at 24 weeks who subsequently developed preeclampsia. Among 4 patients of preeclampsia and eclampsia, 3 had 2nd trimester uterine and 3rd trimester umbilical Doppler abnormalities and only 1 had normal doppler indices. In 2nd trimester the sensitivity, specificity and PPV are higher for uterine artery PI as compared to umbilical artery PI. Hence, uterine artery doppler seems to be a better screening tool for early prediction of PIH. The third trimester umbilical artery PI with higher specificity (96%) and PPV (50%) can diagnose preeclampsia better. One patient had absent diastolic flow and she developed preeclampsia and IUGR. The combined uterine and umbilical artery doppler is a better screening modality as it has a higher sensitivity (75%) and NPV (99.26%).</p> <p><strong>Conclusion:</strong> The uterine and umbilical artery Doppler velocimetry are potential tools for uteroplacental surveillance of high-risk pregnancies which can identify patients at risk and help in taking timely action to prevent complications.</p> Rohini Singh Sudipa Mondal Manisha Bajaj Debasmita Mandal Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 135 141 10.3126/ajms.v12i10.38390 Forensic age assessment using Kvaal’s method with digital orthopantomographs (OPG) and comparison with the actual age of the subjects https://www.nepjol.info/index.php/AJMS/article/view/38349 <p><strong>Background:</strong> Forensic Dentistry is one of the branch of Forensic Medicine which deals with the complete handling of dental evidence, estimation and examination and the evidence obtained would be used in the court for justice. Kvaal and Solheim given a method used on adults for calculation of age with the help of morphological and radiological methods, but extraction was still required. Hence to improve this procedure Kvaal et al made a method which is totally based on radiological analysis.</p> <p><strong>Aims and Objective:</strong> The present study was designed to compare the forensic age assessment using Kvaal’s method and digital orthopantomographs with the actual age of the subjects.</p> <p><strong>Materials and Methods:</strong> Present observational study was conducted in subjects with all the required complement of teeth on either right or left side, completely erupted clinical crown, without any morphological abnormalities for age estimation by Kvaal’s method with digital orthopantomograph as and compared with actual age of subjects.</p> <p><strong>Results:</strong> In the present study out of 100 subjects, maximum number of subjects i.e. 61 were in the age group of 20 – 29 and minimum number of subjects i.e. 7 were in the age group of 50 –59. 43 were females and 57 were males. The regression equation was derived for all six studied teeth and coefficient of determination R2 was found for all the individual six teeth. Coefficient of determination was highest for lower first premolar (0.517) followed by upper central incisor (0.178), lower canine (0.134), lower lateral incisors, upper second premolar and upper lateral incisors. M &amp; W-L were found significant predictors for lower first premolar, lower canine and upper central incisors. Similarly, coefficient of determination (R2) was significant higher for lower three teeth (0.478) than upper three teeth (0.069) with M &amp; W-L were significant predictor. Regression equation derived for all six teeth together shows significant coefficient of determination R2(0.430) with M, W-L both are significant predictors. No statistically significant difference between the actual age and estimated age for all individual six teeth was noted. Mean difference lowest for lower first premolar (0.001) followed by lower canine (0.007).</p> <p><strong>Conclusion:</strong> We noted that age assessment using Kvaal’s method with digital orthopantomographas and actual age of the subjects were comparable &amp; no significant difference was noted. Kvaal’s method with digital orthopantomographas is a better option for age estimation without teeth removal.</p> Azia Manzoor Vinka Maini Wasim Manzoor Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 142 146 10.3126/ajms.v12i10.38349 Derivation of regression equation for estimation of stature by using measurement of femur https://www.nepjol.info/index.php/AJMS/article/view/37948 <p><strong>Background:</strong> Reconstruction of stature from broken fragments of bones is used as a part of the analysis in forensic anthropology for the purpose of identification of an individual. Long bones are traditionally used for estimation of stature. Long bones such as femur and tibia are the most important components of an individual’s stature. In the present study, regression equation was derived for estimation of maximum femoral length from measurements of the proximal end of femur.</p> <p><strong>Aims and Objectives:</strong> To derive regression equations using femur length from measurements of neck-shaft angle and maximum vertical diameter of femur head.</p> <p><strong>Materials and Methods:</strong> Two hundred unpaired femurs, devoid of gross pathology and irrespective of gender obtained from the Department of Anatomy of both VMKVMC &amp;VMHMC were used for this study. The correlation coefficients of the neck-shaft angle and maximum diameter of head of femur to the maximum length of femur was calculated. These co-efficient were used for formulation of regression equation.</p> <p><strong>Results:</strong> The present study was done to show that the maximum length of femur can be best calculated from the metric evaluation of vertical diameter of the head when the proximal fragments are available. The parameters in our study which includes maximum vertical diameter of the head showed positive correlation but the neck- shaft angle showed a low correlation and is not reliable to measure MFL from it.</p> <p><strong>Conclusion:</strong> The present study concludes that the maximum length of femur can be best calculated from the metric evaluation of vertical diameter of the head when the proximal fragments are available.</p> Diana Laishram Shanta Chandrasekaran Deepti Shastri Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 147 151 10.3126/ajms.v12i10.37948 Pattern of superficial venous arrangement in cubital fossa among preclinical Nepalese MBBS students at Birat Medical College Teaching Hospital https://www.nepjol.info/index.php/AJMS/article/view/39248 <p><strong>Background:</strong> The superficial veins of the cubital fossa are frequently variable in existence and arrangement. Many clinical procedures, such as reconstructive microsurgery and arterial bypass surgery, as well as intravenous injections or therapy, require the use of superficial veins.</p> <p><strong>Aims and Objective:</strong> The aim of the study was to observe and describe the variations in anatomical distribution of the superficial veins of the cubital fossa in Nepalese pre-clinical medical students.</p> <p><strong>Materials and Methods:</strong> The cross-sectional study included a total of 98 students between 18 to 24 years of age. A total of 196 anterior aspects of both arms were examined for cubital venous pattern. A tourniquet was applied at the mid-arm and drawing of the pattern of veins was made on a separate unglazed paper. The venous patterns in the cubital fossa were then categorized based on their gender.</p> <p><strong>Results:</strong> Six patterns of superficial veins of the cubital fossa were observed. The commonest pattern in both genders was type I pattern. No statistical significant difference was observed between patterns of superficial veins on the right and left cubital fossa (P = 0.728 and 0.825 respectively) in both male and female subjects.</p> <p><strong>Conclusion:</strong> Our research showed six venous patterns of superficial veins at the cubital fossa in Nepalese population. Understanding the common anatomy, patterns and variations of superficial vein anastomosis is imperative as this knowledge would help those needing venous access for various medical procedures.</p> Sanjib Kumar Sah Sidarth Timsinha Raju Kumar Chaudhary Rajesh Kumar Shah Umesh Kumar Mehta Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 152 156 10.3126/ajms.v12i10.39248 Evaluation of Cephalic Index in children from the Madheshi community in Sarlahi district, Nepal https://www.nepjol.info/index.php/AJMS/article/view/37924 <p><strong>Background:</strong> Cephalic index is one of the important craniofacial parameters which is commonly used for investigating the length and breadth of the head. Cephalic Index (CI) is defined as the ratio between maximum breadth of the head and the maximum length of the head multiplied by 100. Body mass index (BMI) is a nutritional marker of the body derived from the measurement of height (in m2) and weight (in kg).</p> <p><strong>Aims and Objective:</strong> To analyse the effect of BMI on the CI.</p> <p><strong>Materials and Methods:</strong> This study was a cross-sectional study conducted from April 2021 to June 2021 with sample size of 200 children of age groups 5-8 years from Ramnagar Gaupalika of Sarlahi, Province 2, of Nepal. We measured the cephalic index of the children and asked a set of structured questionnaire to the guardian or parent of the children. Height and weight of the children were also measured and BMI was determined. Data analysis was completed using SPSS version 16.</p> <p><strong>Results:</strong> The mean age of the participants was 6.56 years, BMI of 18.09 and cephalic index (CI) of 81.82. The mean CI in males and females were 82.05 and 81.59 respectively. Our results show significant association between BMI category and CI category (chisquare test, p-value=0.000), mode of delivery and BMI category (chisquare test, p=0.042) and significant negative correlation between BMI and CI (Pearson’s R=-0.591, p=0.037).</p> <p><strong>Conclusion:</strong> The most common pattern of CI was hyperbrachycephalic in the children of low BMI whereas the pattern of CI in case of the normal BMI was the mesocephalic type. It also confirmed that the sexual dimorphism exists in both the low BMI and the normal BMI.</p> Surendra Kumar Sah Man Kumar Tamang Om Prakash Yadav Amit Kumar Shah Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 157 160 10.3126/ajms.v12i10.37924 A morphometric study on the articulating facets of talus in North Indian population https://www.nepjol.info/index.php/AJMS/article/view/37766 <p><strong>Background:</strong> Morphometry of talus will be helpful for radiologists, orthopaedicians and surgeons for diagnosis and treatment of talar fractures and making bone prosthesis.</p> <p><strong>Aims and Objectives:</strong> The purpose of our study is to do a morphometric analysis of talus to facilitate orthopedicians in planning surgeries for subtalar implants and foot prostheses. This will be of great use to forensic anthropologists.</p> <p><strong>Materials and Methods:</strong> For the study, 60 dry adult human tali (24 left and 26 right) were obtained from the Department of Anatomy, SGT Medical College, Budhera. The morphometry of talar surfaces was done using a digital caliper accurate to 0.01 mm and data was recorded.</p> <p><strong>Results:</strong> The mean values of medial, central and lateral length on the trochlear surface were 27.0cm, 28.1cm, 27.4cm on right side and 29.4cm, 27.0cm, 29.1cm on left side. Mean anterior, central and posterior widths on the trochlear surface were 27.6cm, 26.2cm, 21.1cm on right side and 27.0cm, 24.0cm, 23.1cm on left side. The mean central height and width on the lateral articular surface was 26.2 cm and 21.9 cm on the right side respectively and 23.0 cm and 16.8 cm on the left side respectively. The mean central height and central width on the medial articular surface was 13.6 cm and 25.9 cm on the right side respectively and 10.8cm and 17.9 cm on the left side respectively.</p> <p><strong> Conclusions:</strong> The current study would be helpful as an important tool for reconstruction surgeries of hindfoot deformities and foot reconstruction procedures. Also it would be useful to orthopaedicians to design accurate talus bone prosthesis and talar implants. Morphometry of talus will be of use in objective categorization and race<br />determination for forensic purposes.</p> Shavi Garg M/s Usha Verma Arpita Suri Kirandeep Kaur Aulakh Copyright (c) 2021 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 2021-10-01 2021-10-01 12 10 161 163 10.3126/ajms.v12i10.37766