bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vitiligo - An Indian Perspective
Authors: Kanwar A.J. 
Published: May 2020

The prevalence of vitiligo in India is high. It affects DLQI. Exact aetiology is not clear. Melanocytorrhagy hypothesis is important. Classification into segmental and non segmental vitiligo is satisfactory from prognosis and treatment point of view. Onset of vitiligo after the age of 30 years is defined as late onset vitiligo: separate subset with strong genetic background and presence of precipitating environmental factors. Mucosal vitiligo is a distinct subset. Koebner type 2 A phenomenon needs redefining.
Oral minipulse and minocycline are effective in progressive unstable vitiligo. Narrowband UVB phototherapy is effective in both children and adults: it has an edge over PUVA. NCECS is the most common surgical technique used in treatment. Suspension in patient's serum gives better results. NCECS is better than SEBG. Camouflaging and depigmentation are required in some cases.
Global Burden of Mental Disorders: Meeting the Challenge
Authors: Chadda Rakesh K. 
Published: May 2020

SUMMARYMental disorders are one of the major contributors to the global burden of disease, constituting about 14% of the burden. Both severe mental disorders (SMDs) as well as the common metal disorders (CMDs) contribute to the global burden of disease and are responsible, and need active intervention on the part of mental health experts and the health planners. Inadequate mental health resources and a large untreated population are important contributors to the burden. Thus the global burden of disease due to mental disorders imposes a major challenge. Possible solutions include enhancing the manpower resources, improving the mental health literacy, integration of mental health in general medical care and active community participation. Under the National Mental Health Programme of India, a number of such activities have been undertaken. The primary care doctors are also an important resource, since they provide care to a vast majority of the patients with CMDs. Strengthening primary care for the mental disorders, raising community awareness, mental health promotion, and control of alcohol and substance abuse could be important strategies in meeting the challenge. There is also need for creating services for enhancing welfare measures for the patients with disability due to mental disorders. Barriers to the mental health care and services also need to be tackled.
Simulation Based Skills Training in Neurosurgery and Contemporary Surgical Practices
Authors: Suri Ashish , Tripathi Manjul , Bettag Martin , Roy Tara Sankar , Lalwani Sanjeev 
Published: May 2020

SUMMARYNeurosurgery training is based on a time-bound apprenticeship model, resulting in mentor-dependent, non-uniform, anecdotal, slow skills acquisition, sometimes with morbid consequences. The complexity of neurosurgical procedures and constraints of present education have demands for alternative methods of training. The use of simulation in surgical skills training was pioneered by work in laparoscopy, which began only in the last 25 years. Existing neurosurgery training model should be supplemented with efficient skills training curricula.The present study illustrates formulation, standardization, validation and evaluation of efficacy of neurosurgery skills training modules using formative and summative assessment. 160 regular residents and short-term trainees were trained over 3096 skills training sessions under formative assessment; 176 'graduate neurosurgeons' were trained with 12 skills training programs under summative assessment. Training involved skills development in micro-neurosurgery, high-speed drilling, neuroendoscopy and spine-instrumentation by practice on structured low and high-fidelity simulation models. The effectiveness of content, course modules, and teaching faculty on skills development were assessed using spot and gap-based evaluation.Seven basic, 7 intermediate and 14 advanced skills training modules have been developed. Trainees rated 71% of overall training sessions as excellent quality content with 69·8%, 70·1%, and 71% respectively for micro-suturing and high-speed drilling, neuro-endoscopy and spine-instrumentation modules. Faculty with higher ratings was included as program instructors. On gap-based evaluation, >80% of responded trainees reported better orientation with high speed drilling followed by micro-neurosurgery and spine-instrumentation. Neuro-endoscopy training scored low assimilation into clinical practice.We suggest structured modular validated skills training curriculum to supplement the existing neurosurgery training. This would help in improving learning curve outside operation-rooms, at convenience and individualized needs of trainees under supervision, and would thus help in skills translation without endangering patients.
Cervical Cancer – Bench to Bedside
Authors: Rajkumar T. 
Published: May 2020

AbstractCervical cancer is the second most common cancer in Indian women and 4th most common cancer in women world-wide. Over nearly two decades, we have carried out epidemiological and molecular studies in cervical cancer, with an intent to identify potential early diagnostic biomarkers, predictive and prognostic markers, develop newer therapies against cervical cancer and identify potential new targets for therapy.Our studies had identified 14 high risk and 10 low risk human papilloma virus (HPV) in our cervical cancer patients for the first time; had identified life style related cofactors in the development of cervical cancer (paan chewing, parity, early age at first sexual intercourse and first childbirth, husband with two or more sexual partners). We have developed a p16 ELISA kit for cervical cancer screening for use at point of care like PHC's; identified a 7 gene signature which help identify patients who can be treated with radiotherapy alone; identified potential prognostic markers for use in the clinic; developed the country's first Dendritic cell vaccine therapy for cervical cancer and completed the phase 1 study; have identified newer potential therapeutic targets for treatment of cervical cancer.
Clinical Epidemiological Study of Oral Pre-cancer and Cancer in a Tertiary/Referral Hospital
Authors: Jayachandran Sadaksharam 
Published: May 2020

Abstract
Aim: To study the prevalence of oral cancer in patients reported to the Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital.
Materials and Methods: After selecting the patients with the clinical criteria the history of the habits, duration in months and frequency per day, duration of the symptoms, oral mucosal site involvement, lymph node involvement, associated with lesions were recorded in a structured proforma. Incisional biopsy under Local anaesthesia and histological examination was performed. The results obtained were analysed statistically.
Results: 200 patients were diagnosed with oral cancer, 49% were male and 51% were females. In that 51(25%) were associated with premalignant lesions, 94 had only one habit, 74 had a combination of habits, 40% were histopathologically moderately differentiated followed by 33% poorly differentiated and 27% well differentiated. And patients with stage III (31%) and IV (43%) were reported predominantly than stage I (12%) and II (14%).
Conclusion: Early diagnosis and intervention prevent the progression of oral cancer.
Short Answer Open-Ended versus Multiple-Choice Questions: A Comparison of Objectivity
Authors: Mehta Bharati , Bhandari Bharti , Sharma Parul , Kaur Rimplejeet 
Published: May 2020

Objectives:
We designed our study with the hypothesis that open ended Short Answer type Questions (SAQs), no matter how carefully framed, cannot be as objective as Multiple Choice type Questions (MCQs).

Methods:
The study was conducted on 1st year MBBS students (n=99) studying at AIIMS, Jodhpur. A written test on 'Blood & Immunity' was conducted containing same questions in two formats; twelve MCQs (type E) in section A and 12 SAQs in section B. Maximum marks for all questions in both sections were equal. All the answers of section B were evaluated separately by two different examiners to reduce the subjectivity and a model answer sheet for both the sections was prepared and provided to both the examiners.

Results:
The difference in the scores in Section B SAQs that were evaluated by two different examiners was not statistically significant. Mean of the marks awarded by the two examiners was taken as the final score of each student in section B. The difference in the scores by the students in the two sections was also non-significant (p=0.14). A significant correlation (r=0.99, p<0.0001) was found in SAQ and MCQ scores. Bland- Altman analysis also showed no proportion of bias and the two methods of scoring were in agreement with each other.

Conclusion:
The results suggest that meticulously-framed open-ended short answer type questions can be as objective as multiple choice type questions.
Custom Mega Prosthesis in Metachronous Osteosarcoma
Authors: Natarajan MV , Mohamed Sameer M , Upadhyay Upasana , Kumar MD 
Published: May 2020

Background:
The objective of the current study was to determine the incidence, clinical and pathologic characteristics, and outcome of patients with conventional osteosarcoma who developed metachronous tumours and treated by limb salvage surgery with Custom Mega Prosthesis.

Methods:
Among 1198 osteosarcoma patients who were treated with limb salvage surgery and implantation of custom mega prosthesis, 6 patients were found to have metachronous lesions. The absence of pulmonary metastases was confirmed by chest radiographs and computed tomography while radionuclide bone scan and biopsy were used to confirm the absence of skeletal metastases. The patients were treated by limb salvage surgery with custom mega prosthesis for the metachronous tumour and functional outcome was evaluated by MSTS scores.

Results:
Index primary tumours involved the femur (n=3) and the tibia (n=3) and were treated with limb salvage surgery using endoprosthetic reconstruction. Single metachronous tumours developed in the all of these patients with the interval between identification of the primary tumour to development of the metachronous tumours varying from 18 months to 41 months. All metachronous tumours were treated with neoadjuvant chemotherapy and limb salvage surgery. We obtained excellent functional outcome for primary tumours and good functional outcome for metachronous tumours. Two patients succumbed to disease due to pulmonary and cerebral metastasis during follow-up.

Conclusions:
With advances in survival rate in the multidrug chemotherapy era in the post tumoursresection period, advanced diagnostic modalities help in diagnosing metachronous osteosarcoma. It should be recognized as important sequelae in long-term survivors. Meticulous follow-up is required to permit early detection and successful therapeutic intervention. Limb salvage surgery has provided consistent good results in metachronous osteosarcoma patients.
Burden of Cardiometabolic Disorders among Subjects Undergoing Preventive Health Check-up: A Follow-up Study
Authors: Pande Jitendra Nath , Kaur Manpreet , Sachdev Harshpal Singh 
Published: May 2020

Objective:
To study the incidence of hypertension (HTN), diabetes mellitus and coronary artery disease (CAD) in a cohort of adult subjects.

Methods:
A total 2159 participants (mean age: 48.6±11.6 years; 1342 males and 817 females) who attended the hospital for a comprehensive health check up were recruited and followed-up as a cohort for a mean period of 3.5 years. Their baseline and follow-up evaluation included clinical examination, biochemical investigations and cardiac check-up.

Results:
At baseline, 64% participants were overweight or obese, 44.3% had HTN (grade I or above), 16.7% had diabetes mellitus with additional 29.3% having impaired fasting glucose or glucose intolerance, and 46.6% had metabolic syndrome. The prevalence of CAD at baseline was 6% in males and 3% in females. The incidence (per 1000 person-years of follow-up) of HTN, diabetes mellitus and CAD was 72.2, 26.3 and 12.2, respectively.

Conclusion:
The burden of cardiometabolic disorders and their risk factors is high in India. Urgent remedial public health preventive measures are required to curtail the emerging epidemic of cardiometabolic disorders.
Role of Uroflowmetry in Children with Ano-Rectal Malformation in Anticipating Upper Urinary Tract Damage
Authors: Saxena Rahul , Sinha Arvind , Pathak Manish , Jadhav Avinash S , Bansal Ankur 
Published: May 2020

Background:
The lower urinary tract dysfunction (LUTD) has high incidence in children with anorectal malformation (ARM) which if left untreated leads to upper tract damage.

Aim:
To determine role of uroflowmetry in early diagnosis of LUTD in children with ARM.

Methods:
This prospective study included twenty consecutive patients of ARM and every patient underwent uroflowmetry at-least 6 weeks after definitive procedure.

Results:
The mean age of patients was 3.015±0.86 years. Of the twenty patients, there were 12 (60%) males and 8 (40%) females; 11 (55%) were high ARM, 4 (20%) were intermediate and 5(25%) were low ARM. Lower urinary tract symptoms (LUTS) was present in 8/20 (40%) patients but uroflowmetric abnormalities were present in 11/20 (55%) patients. Forty five percent (5/11) patients with abnormal uroflowmetry were asymptomatic and 25% (2/8) symptomatic patients had normal uroflowmetry. The incidence of uroflowmetric abnormalities was significantly higher in patients with spinal anomalies (p=0.03; χ2=4.1) and those with high ARM (p=0.004; χ2=8.1).

Conclusion:
Uroflowmetry is a noninvasive method that may help in early detection of neurovesical dysfunction in asymptomatic children and subsequent cystometric analysis in patients with uroflowmetric abnormalities can be done for early definitive diagnosis and prevention of upper urinary tract damage.
Association of Vitamin D and Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus
Authors: Parveen Rizwana , Mishra Pinki , Singh Reema , Kapur Prem , Agarwal Nidhi B. 
Published: May 2020

Objective:
To assess the association of vitamin D (VD) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).

Method:
Literature search was conducted for studies assessing the association of VD and DR. Total 9 studies have a sum total of 1741 patients were included for final analysis.

Results:
The concentration of VD in controls ranged from 17.5±3.6 to 31.9±12.9 ng/ml, while for T2DM patients without retinopathy it ranged from 11.94±4.21 to 23.10±6.12 ng/ml. T2DM patients with retinopathy had the lowest concentration, ranging from 10.02±5.61 to 19.25±7.86 ng/ml. A higher percentage of T2DM patients without (50.7% to 68.80%) and with (31.2% to 79.63%) retinopathy had VD deficiency (VDD).

Discussion:
An inverse association between VD levels and DR was observed. The concentration of VD decreases as the stage of DR advances. VD seems to be an easily modifiable risk factor for DR. Thus, VD supplementation should be encouraged in population at higher risk for diabetic complications.
Introducing the Team Based Learning as an Approach to Reviving Interest in Biochemistry amongst Undergraduate Medical Students-An Exploratory Study
Authors: Lal Vanita , Bhandari Bharti , Gupta Garima , Singh Kuldeep , Sharma Praveen 
Published: May 2020

Introduction:
Much emphasis has been given to different approaches to active learning. Our primary objective was to elicit interest amongst students in the areas of neglected, difficult topics in Biochemistry. Encouraging team building and developing team spirit by roping in all students in the exercise was the secondary objective of our study.

Methods:
It was a single blind controlled interventional study. A Team Based Learning (TBL) Module was developed for First Professional MBBS students of 2015 batch. The topics selected were of high difficulty level. Ten groups were formed by random allocation. Study materials and reference sources were displayed and distributed two weeks prior to the initiation of TBL sessions. Each TBL session consisted of pre-test preparation (through didactic lectures and self-study), MCQ-based pre-test, application of concepts, Problem Based Questions (PBQs), reviewing and post-test. This was followed by administration of feedback questionnaire. The data obtained were analysed using SPSS version 21.

Results:
When the pre-test and post-test marks were compared, significant improvement in the students' performance was observed (p<0.05). According to students' feedback, the learning exercise was innovative, beneficial, helped in better comprehension of difficult topics, increased in-depth knowledge on the topic, fun-filled and relaxing, eventually leading to better learning. Students were able to analyse and give rational and logical responses to complex PBQs. There was an increase in interest towards reading and referring in detail about the topics allotted to them. Library usage and issue of reference books as seen in the logbook increased rapidly. They were more confident in Biochemistry after conducting a series of TBL sessions. While comparing the performance marks after the TBL sessions with that after classroom didactic lecture method, students were of the view that TBL was better than lectures. The difference in scores obtained by two groups (2016 vs. 2015) was significant. The groups who were exposed to TBL had far better scores than those exposed to lectures in the same topic.

Conclusion:
The focus these days is on self-directed learning for medical students to become selfregulated, independent learners, which is essential for acquiring competencies and TBL appears to be one such modality.
Role of Adipokines in Development of Metabolic Syndrome
Authors: Gupta Vani 
Published: May 2020

Visceral adipose tissue releases a variety of adipokines which together determine a comprehensive cardiometabolic risk profile. Estrogen deficiency leads to central fat deposition in postmenopausal women. However, premenopausal women are also running high risk of central obesity owing to unhealthy lifestyles, making them prone to development of metabolic syndrome which leads to infertility, polycystic ovary syndrome (PCOS), insulin resistance, and type 2 diabetes (T2D).
Premenopausal women with (n=30) and without (n=30) central obesity were studied. Metabolic risk factors and circulatory adipokines were measured. Insulin resistance was calculated by homeostasis model assessment (HOMA-IR). Adipokines' gene polymorphisms were studied by polymerase chain reaction and mRNA expression of leptin, adiponectin, resistin, and interleukin-6 (IL-6). Tumour necrosis factor-α (TNF-α), acylation stimulating protein (ASP) receptor gene (C5L2) were done by real time-polymerase chain reaction in visceral (VAT) and subcutaneous (SAT) adipose tissues was also obtained.
Significant high circulating leptin, IL-6, TNF-α, resistin and their VAT mRNA expression and significant low circulating adiponectin and VAT mRNA expression were found in women with metabolic syndrome, irrespective of their menopausal status. Carriers of mutant genotype of TNF-α 308 AA, IL-6 174 CC, resistin 420 GG, leptin 2549 AA, adiponectin 276 TT and C5L2 698 CT had significant association with metabolic syndrome. Conclusively changes in fat distribution modulate the secretion profile of adipokines, therefore elevated circulating leptin, IL-6, TNF-α, ASP, resistin, and low adiponectin may serve as surrogate markers for metabolic syndrome and related morbidities in women with central obesity.
Molecular and Functional Basis of Cystic Fibrosis in Indian Patients: Genetic, Diagnostic and Therapeutic Implications
Authors: Prasad Rajendra 
Published: May 2020

Cystic fibrosis (CF, MIM#219700) is a common autosomal recessive disorder among Caucasians, which was considered as rare disease for Indian population. CF is caused due to presence of mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. In this study, we established a spectrum of mutations from both classical CF as well as from infertile male patients with congenital absence of vas deferens (CAVD). In Indian classical CF patients, we reported 14 previously known and eight novel mutations, viz. 3986-3987 delC, 876-6 del4, 1792 InsA, L69H, S158N, Q493L, 1530L and E1329Q. The frequency of delta 508 was found to be 27%. Absolute linkage between delta 508 and KM19-GATT TUB9-M470V-T854T haplotype predicts a relatively recent appearance of delta 508 mutations in Indian population. The CFTR gene analysis in CAVD infertile males documented 13 different CFTR gene mutations and 1 intronic variant that led to aberrant splicing. P.Phe 508 del (n= 16) and p.Arg 117 His (n=4) were among the common severe forms of CFTR mutations identified. The IVS-8-T5 allele (mild form of mutations) was formed with an allele frequency of 28.3%. Eight novel mutations were also found in the CFTR gene from our patient cohort. We also investigated whether genetic modifiers, viz. transforming growth factor (TGF-β) and endothelial receptor type A (EDNRA) of CF lung disease also predispose to CAVD in association with CFTR mutations, which were associated with the CAVD phenotype.
Functional characterization of identified 11 novel CFTR gene mutations disclosed that a significant reduction in channel activity for L69H and S549N mutants in CFTR expressing cells was observed whereas impaired CFTR protein maturation was noticed only in L69H substitute CFTR. CFTR correctors (VX809) rescued the defect due to L69H mutation, which is evidenced from detection of C band in L69H mutant expressing cells pre-treated with VX809. The chloride channel activity in S549N and L69H mutant CFTR was also restored in presence of CFTR potentiators VX770.
Above findings confirms heterogeneity of CFTR mutations in Indian classical and non-classical CF patients. They may help in developing a strategy to develop counseling and therapeutic approach for CF patients in India.
Carbamazepine, Sodium Valproate and Levetiracetam Modulate Wnt Inhibitors in Indian Women with Epilepsy
Authors: Parveen Bushra , Tripathi Manjari , Divya Vohora 
Published: May 2020

Background:
Antiepileptic drug (AED) therapy has been claimed to deteriorate bone health. Majority of the research was inclined towards vitamin-D deficiency as the patho-mechanism. However, after the role of Wnt in bone metabolism was discovered, it has paved way for investigating the role of Wnt inhibitors in mediating effects on bone accrual. Recently, we have reported the modulation of two Wnt inhibitors, sclerostin and dickkopf-1 (DKK-1), following AED therapy in Indian women with epilepsy, however, the subgroup analysis for individual drug is elucidated in this report.

Methods:
Individual analysis for our earlier cross-sectional study on three AEDs, carbamazepine (CBZ), sodium valproate (SVP) and levetiracetam (LTM), on sclerostin and dickkopf-1, and their correlation with receptor activator of nuclear factor kappaB ligand (RANKL) and serum 25-hydroxy vitamin D (25OHD) was assessed in Indian women with epilepsy.

Results:
We observed enhanced sclerostin and 25OHD levels with all three AEDs while serum RANKL was higher with SVP and LTM only. Further, serum DKK-1 levels were lowered with CBZ and LTM. Sclerostin showed a positive correlation with RANKL in CBZ group, while DKK-1 presented no such relationship.

Conclusion:
As sclerostin is more specific than DKK-1, we may conclude that these drugs may compromise bone health through disturbance in Wnt signaling mechanisms.