Asian Journal of Medical Sciences <p>The inaugural issue of the Asian Journal of Medical Sciences was published in May 2010. Full text articles available.</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="" 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="" target="_new">The Effect of Open Access</a>).</li></ol> Lipoprotein-associated phospholipase A2 in relation to lipid markers: A pan-India correlation study <p><strong>Background:&nbsp;</strong>Conventional serum markers are routinely recommended to assess heart health. However, many new biochemical markers like lipoprotein-associated phospholipase A2 (Lp-PLA2) has been studied as an efficient cardiac risk marker. Our report is an attempt to present correlation between traditional lipid markers and Lp-PLA2 in a pan-India cohort.</p> <p><strong>Materials and Methods:&nbsp;</strong>The study cohort included a total of 10347 pan-Indians including 5945 males and 4402 females respectively. The serum lipid parameters estimated include triglycerides, LDL- and HDL-cholesterol as well as total cholesterol by the technology of photometry.</p> <p><strong>Results:&nbsp;</strong>The frequency of high Lp-PLA2 detected in our study was 6.4% and the frequency between males at 9.3% and females at 2.5% was detected to be significant at p&lt;0.0001. Linear regression analysis detected significant positive association of high Lp-PLA2 with LDL-cholesterol and total cholesterol at p&lt;0.05, while the trend with HDL-cholesterol was also significant. However, Lp-PLA2 as an independent marker was not detected to be significant in relation to the lipid indices studied.</p> <p><strong>Conclusion:&nbsp;</strong>Though Lp-PLA2 has been associated with risk factor for acute coronary crisis, its clinical value remains controversial. Our report though detected significant association of Lp-PLA2 with various lipid parameters, independent value remains questionable.</p> Sandhya Iyer Rajkumar Kushawaha Prachi Sinkar Sivakumar Selvaraj Amruta Velumani ##submission.copyrightStatement## 2019-05-01 2019-05-01 10 3 1 6 10.3126/ajms.v10i3.22791 Comparative analysis on association of fasting and postprandial dyslipidemia with risk of atherosclerosis in early rheumatoid arthritis <p><strong>Background:</strong> Rheumatoid arthritis (RA) patients have higher cardiovascular risk due todyslipidemia, inflammation etc. The serum lipid levels obtained after 12 hour fasting will not truly reflect atherosclerotic risk associated as non fasting state predominates in routine life.</p> <p><strong>Aim and Objectives:</strong> We investigated the frequency of dyslipidemia in early RA cases and healthy controls in both fasting and postprandial state and analyzed the impact of postprandial lipid profile over fasting lipid levels in prediction of atherosclerotic risk.</p> <p><strong>Materials and Methods:</strong> This case-control study was conducted at UCMS and GTB Hospital, Delhi. 127 RA cases diagnosed according to revised ACR, 2010 with age and sex matched 127 controls were recruited. Lipid profile parameters were analyzed by commercial kits on auto analyzer. RF, anti-CCP, TNF-α and CRP were measured by ELISA. For statistical analysis unpaired t test and Pearson’s correlation was used.</p> <p><strong>Result:</strong> The mean disease duration was 7± 2.16 months. There were significant increased levels of TC, LDL-C, and TAG with reduced serum HDL-C in RA cases. Atherogenic ratio of TC/HDL-C and LDL-C/HDL-C were significantly high in RA. Postprandial lipid analysis revealed significant difference for TAG and HDL-C in RA cases. TAG had a significantly positive correlation with TNF-α (r=0.234) which improved in postprandial state(r=0.559). Significantly negative correlation of HDL-C with ESR (r=-0.221) also improved (r=-0.421) postprandially.</p> <p><strong>Conclusions:</strong> Atherogenic dyslipidemia was a significant finding in patients of early RA. Dyslipidemia screening can be recommended in postprandial state.</p> Puja Kumari Jha Rafat Sultana Ahmed Rachna Agarawal ##submission.copyrightStatement## 2019-05-01 2019-05-01 10 3 7 12 10.3126/ajms.v10i3.23283 Skin color variation: A study on Eastern and North East India <p><strong>Background:</strong> Skin pigmentation is one of the most variable phenotypic traits and most noticeable of human polymorphisms. Skin pigmentation in humans is largely determined by the quantity and distribution of the pigment melanin. The literature review on skin color variation revealed a few works on skin pigmentation variation has been conducted in India from Southern, Western and Northern part.</p> <p><strong>Aims and Objectives:</strong> To best of the knowledge, the present discourse is the first attempt to understand skin color variation from Eastern and North Eastern part of India among three populations.</p> <p><strong>Materials and Methods:</strong> The present study consisted of 312 participants from Chakma and Tripuri groups of Tripura, North East India, and participants from Bengalee Hindu caste population from West Bengal. Skin color was measured by Konica Minolta CR-10 spectrophotometer which measures and quantifies the colors with a 3D color space (CIELAB) color space created by 3 axes. All the skin color measurements from each participant were taken from unexposed (underarm) left and right to get a mean and exposed (forehead) to sunlight.</p> <p><strong>Results:</strong> The distribution of skin color variation among the three populations demonstrated significant (p&lt;0.05) difference in lightness for unexposed and exposed indicating lightness in unexposed area. Furthermore, the present study revealed significant difference (p&lt;0.05) in skin color among the ethnic groups across the body location and all three attributes (lightness, redness and yellowness).</p> <p><strong>Conclusion:</strong> Generally, skin color variation may be elucidated by two main factors: individual differences in lightness and yellowness and by and large due to ethnicity, where diversity in redness is due to primarily due to different body locations. Variation in lightness have more characteristic probability. The present study first time reports the wide range of quantitative skin color variation among the three ethnic groups from Eastern and North East India and highest yellowness (b*) among the population from North East India.</p> Sumit Maitra Diptendu Chatterjee Arup Ratan Bandyopadhyay ##submission.copyrightStatement## 2019-05-01 2019-05-01 10 3 13 16 10.3126/ajms.v10i3.23256 ASD device closure in elderly adults <p><strong>Background:</strong> Closure of ASDs in elderly patients caused significant clinical and hemodynamic improvement after device closure.</p> <p><strong>Aims and Objective:</strong> We aim to share our experience of ASD device closure in elderly adults.</p> <p><strong>Materials and Methods:</strong> It was a prospective single center study done at Shahid Gangalal National Heart Centre. All elderly patients (&gt;50years) who underwent ASD device closure fromFeb 2016 to July 2018 and completed three months of device closure were prospectively follow up for the symptoms, RA and RV dimension, Tricuspid Regurgitation and Tricuspid Regurgitation pressure gradient (TRPG).</p> <p><strong>Results:</strong> During the study period 48 elderly adults underwent successful ASD device closure. Except one patient we could follow up all patients. Among the patient’s 33 were female, Age ranged from 50years to 72years with the mean age of 55 years. Shortness of breath was the most common symptom during presentation. ASD size ranged from 10mm to 33mm with the mean of 23mm. Device size ranged from 14mm to 40mm with the mean of 29mm. Amplatzer septal occluder was used in 47 patients. RA and RV were dilated in all patients. Mild TR was present in 26 patients, Moderate TR in 17 patients, Severe TR in 5 patients. Mean follow-up time was 12 months. Symptoms reduced in all patients expect one. RA and RV size reduced in all patients. Tricuspid regurgitation pressure gradient reduced from mean of 56 mmHg to Mean of 16 mmHg. During the follow up level of tricuspid regurgitation reduced, 11 patients had mild TR, Trace TR in 15 patients.</p> <p><strong>Conclusion:</strong> ASD device closure can result in improvement in clinical and hemodynamic in elderly adults.</p> Chandra Mani Adhikari Sachin Dhungel Amrit Bogati Jagat Adhikari Manish Shrestha Kiran Prasad Acharya ##submission.copyrightStatement## 2019-05-01 2019-05-01 10 3 17 20 10.3126/ajms.v10i3.23195 Surgical outcome of intradural extramedullary meningiomas without dural resection – A study on 75 cases <p><strong>Background:</strong> Spinal tumor is a common cause of morbidity in otherwise healthy population, timely diagnosis and treatment of spinal tumor gives excellent outcome.</p> <p><strong>Aims and Objective:</strong> We report experience and clinical outcomes of 75 cases with Intradural extramedullary meningiomas operated in last 21 years.</p> <p><strong>Materials and Methods:</strong> All the patients were clinically assessed with Nurick’s Grading (both pre and post operatively). MRI was the main armamentarium for operating planning. In all the patients dural attachments were coagulated without any dural excision.</p> <p><strong>Results:</strong> Out of 75 patients, 65% were female. Peak incidence was noted in 4th &amp; 5th decade and majority of patients having tumor in the thoracic spine and lateral to the cord. The entire patient showed remarkable clinical improvement according to Nurick’s grade. Total removal was achieved in 69 (90.2%) patients. Two patients had re-growth of tumor in 1 yr. follow up. No postoperative mortality noted in the present series.</p> <p><strong>Conclusion:</strong> Spinal meningioma excision without dural resection did not show any increase in recurrences.</p> Kaushik Roy Partha Ghosh Suniti Kumar Saha Parimal Tripathy ##submission.copyrightStatement## 2019-05-01 2019-05-01 10 3 21 26 10.3126/ajms.v10i3.23569 Two-year prospective study on various anti-epileptic drugs in drug-resistant epilepsy patients and parameters affecting seizure-freedom in Eastern Indian subcontinent <p><strong>Background:</strong> Epilepsy is a disease of suffering. Drug-resistant epilepsy (DRE) takes a heavy toll on patients, family and society in the form of prolonged treatment, expenditure, unemployment and disability. Successful treatment depends on appropriate antiepileptic drug (AED) use in appropriate dosage, which varies in different parts of the world.</p> <p><strong>Aims and Objectives:</strong> To find out AED efficacy in Indian subcontinent and factors affecting seizure freedom.</p> <p><strong>Materials and Methods:</strong> We explored many characteristics of DRE patients, compared in between seizure-free and seizure-persisting patients to find out the variables more affecting seizure-freedom. We measured minimum effective dose and maximum tolerable dose of different AED in child and adult subgroups in patients of the Indian subcontinent.</p> <p><strong>Results:</strong> Lamotrigine was most efficacious in various seizure-types and phenytoin was the least one as first add-on AED. Clobazam was efficacious and good-compliance second add-on AED. AED compliance was significantly reduced as the number of AED was increased above two. AED monotherapy was most effective and the effectiveness decreased as subsequent AED was added as per need.</p> <p><strong>Conclusion:</strong> Our study enlightened about various aspects of drug-resistant epilepsy patients in Indian sub-continent and their treatment.</p> Joydeep Mukherjee Gautam Guha Shankar Prasad Saha ##submission.copyrightStatement## 2019-05-01 2019-05-01 10 3 27 36 10.3126/ajms.v10i3.23481 Histogenesis of suprarenal glands at different gestational age groups <p><strong>Background:</strong> The human foetal suprarenal gland is structurally variant from its adult counterpart. The most distinctive features of human foetal suprarenal gland and histologically unique foetal zone, was described first by Elliott and Armour in 1911. After the first trimester, the centrally located foetal zone accounts for most of the foetal adrenal mass. The outer zone of the foetal suprarenal gland is called the “definitive zone or neo cortex”; this zone likely gives rise to the adult adrenal glomerulosa. A third zone called “transitional zone”, lies just between the neocortex and foetal zone and is believed to develop into the zona fasciculata.</p> <p><strong>Aims and Objectives:</strong> The current study was designed to study the histogenesis of suprarenal glands at different gestational age groups.</p> <p><strong>Materials and Methods:</strong> Twenty-eight formalin preserved dead embryos and foetuses of both sexes, were obtained from the Govt. Maternity Hospital &amp; S.V.Medical College, Tirupati, Andhra Pradesh, India. Specimens were grouped according to their gestational age groups (A,B,C,D) A= 0-12 weeks, B= 13-24 weeks, C= 25-36 weeks and D= more than 36 weeks of gestation. Specimens from group A were subjected to serial section as this group consists of embryos, and other groups were sectioned coronal and subjected to routine histological processing for H&amp;E staining. Sections were observed for cellular details under light microscopy with 10X and 40X magnifications, and the same were photographed by microphotography.</p> <p><strong>Results:</strong> Based upon the gestational age groups, histogenesis of the suprarenal gland was observed and correlated with the available literature, and the detailed results, discussion will be dealt at the time of discussion.</p> <p><strong>Conclusions:</strong> Histological observation of the all the specimens observed in the present study are in agreement with those reported in the literature except that they appeared earlier in the present study than that reported in the literature. Capsule of suprarenal gland appeared at 12 weeks, sympatho-chromaffin bundles appeared before 6 weeks and zonation of cortex was observed at 8 weeks in the present study when compared to the time of appearance reported in the literature as 14 weeks, after 6 weeks and after 12 weeks respectively in the literature.</p> Ravindra Kumar Boddeti Velichety Subhadra Devi ##submission.copyrightStatement## 2019-05-01 2019-05-01 10 3 37 43 10.3126/ajms.v10i3.22820 Serum Reproductive hormone levels in male symptomatic HIV/AIDS patients on Antiretroviral therapy negative to Malaria parasite in Nnewi, Anambra State, Nigeria <p><strong>Background:</strong> AIDS is an endemic disease that causes death among young adults worldwide especially in Nigeria.</p> <p><strong>Aims and Objectives:</strong> This study investigated the serum reproductive hormone levels in symptomatic HIV/AIDS male subjects on ART who are negative to malaria parasite in Nnewi, Anambra State, Nigeria.</p> <p><strong>Materials and Methods:</strong> A total of 274 adult male participants aged between 18 and 60 years were randomly recruited, and grouped into: symptomatic HIV (stage 11) infected male participants on ART (A: n=69), Symptomatic HIV subjects not on ART (B: n= 69), Asymptomatic HIV positive subjects (C: n= 68) and HIV seronegative subjects (D: n= 68). Serum was used to assay for PSA, LH, FSH, Estrogen, Testosterone, Progesterone and Prolactin levels. Analysis of variance and student t-test were used for data analyses.</p> <p><strong>Results:</strong> The serum levels of PSA, FSH, Estrogen, Testosterone, Progesterone and Prolactin were significantly different amongst the groups at p&lt;0.05 respectively. There were significantly higher levels of PSA, Estrogen, Progesterone but lower levels of Testosterone and Prolactin in subjects on ART compared with control at p&lt;0.05 respectively. There were significantly higher levels of PSA, FSH, Estrogen,Progesterone but lower levels of Testosterone in subjects not on ART compared with control at p&lt;0.05 respectively.</p> <p><strong>Conclusion:</strong> The reduction on serum levels of Testosterone and higher levels in FSH, PSA, Estrogen, and Progesterone may reveal presence of hypogonadism, primary testicular failure, prostate abnormalities such as cancer and hyperprogesteronaemia, in symptomatic HIV positives.</p> Priscilla Ifeoma Ezeugwunne Chukwuemeka Emmanuel Ogbodo Adamma Rosemary Analike Nwando Chikaodili Obi-Ezeani Joy Ifeoma Onuora Nwabunwanne Victor Oguaka Kalu Ubou Amah Chukwuemeka Michael Ugwu Chinedum Charles Onyenekwe Eberendu Joseph Ahaneku ##submission.copyrightStatement## 2019-05-01 2019-05-01 10 3 44 49 10.3126/ajms.v10i3.22505 Severe Ovarian Hyperstimulation Syndrome despite low dose stimulation in Polycystic Ovarian Syndrome <p>Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology. There is cystic enlargement of the ovaries along with fluid shift from the intravascular compartment to the third space due to increased capillary permeability and ovarian neoangiogenesis. Severe OHSS is uncommon and the condition can be fatal. Low-dose gonadotropin protocols have been introduced to reduce the risk of OHSS in patients with polycystic ovary syndrome (PCOS). The patient being reported had PCOS and developed severe OHSS despite low dose gonadotropin stimulation; which is a rare scenario.</p> Robin George Manappallil Sivadas Vilakupadath Kokoori Nandini Valsala ##submission.copyrightStatement## 2019-05-01 2019-05-01 10 3 50 53 10.3126/ajms.v10i3.22728 Gentamicin induced acute hypereosinophilia <p>Gentamicin, an aminoglycoside, has been used for the treatment of severe infections by both Gram positive and negative organisms. Nephrotoxicity and ototoxicity are the common adverse effects. The patient being described had urinary tract infection for which he received gentamicin, and developed hypereosinophilia. To the best of our knowledge, this is an unreported event.</p> Robin George Manappallil Mele Chelakkoth Sabir ##submission.copyrightStatement## 2019-05-01 2019-05-01 10 3 54 55 10.3126/ajms.v10i3.23261 The ‘Ivy Sign’ of Moyamoya disease <p>Stroke is uncommon in pediatric age group. Moyamoya is a rare idiopathic disease characterized by progressive vaso-occlusion of the main blood vessels to the brain. We report a case of 13 year old female who presented with recurrent headache and transient left hemiparesis and was diagnosed to have Moyamoya disease. The ‘ivy sign’ is a characteristic magnetic resonance image finding seen in patients with Moyamoya disease.</p> Ummer Karadan Robin George Manappallil ##submission.copyrightStatement## 2019-05-01 2019-05-01 10 3 56 58 10.3126/ajms.v10i3.23196 Primary spinal peripheral primitive neuroectodermal tumor with acute presentation: A case report and review of literature <p style="text-indent: 0cm;">Primary spinal primitive neuroectodermal tumors (PNET) is a rare occurrence and carries a poor prognosis. A 13-year old female patient acutely presented with pain in the thoracic region, bilateral lower limb weakness, bladder and bowel dysfunction. Clinically paraplegia with truncal weakness, lower limb deep tendon reflexes of both side were absent and planter reflexes equivocal bilaterally. Preoperative MRI of thoracic spine revealed D4-D6 extradural SOL. A D4-D5 Laminectomy and left Cortico transversectomy done. Pathological findings were consistent with PNET. The clinical, histopathological, and radiological findings of the patient are presented.</p> Abta Bachchan Kaushik Roy Suniti Kumar Saha Debajyoti Pathak Partha Ghosh Abhishek Nadkarni ##submission.copyrightStatement## 2019-05-01 2019-05-01 10 3 59 61 10.3126/ajms.v10i3.22896 Acute abdomen due to epiploicappendagitis <p>No abstract available.</p> Robin George Manappallil Della Harigovind Unnikrishnan Vijayamukundan ##submission.copyrightStatement## 2019-05-01 2019-05-01 10 3 62 63 10.3126/ajms.v10i3.23656