Cerebral musings on environmental humanities, human transgression, and healthcare preparedness: Looking beyond the “streetlight effect” of the COVID-19 pandemic Bhaskara P Shelley Archives of Medicine and Health Sciences 2020 8(1):1-8

Bedside clinical teaching: Arresting the decline Robert Pickles Archives of Medicine and Health Sciences 2020 8(1):9-10

Computed tomography evaluation of sinonasal masses with histopathological correlation Musaib Ahmad Dar, Suhail Rafiq, Farzana Manzoor, Irshad Mohideen Archives of Medicine and Health Sciences 2020 8(1):11-14 Background and Aim: A variety of nonneoplastic and neoplastic conditions involving the nasal cavity (NC), paranasal sinuses (PNSs), and nasopharynx are commonly encountered in clinical practice. Etiological factors for the development of sinonasal masses are human papillomavirus 6 and 11, allergens, air pollution, and industrial carcinogens, tobacco, alcohol, and occupational exposure to heavy metal particles. The aim was to explicate and corroborate the CT radiological features of sinonasal masses of benign versus sinister differential diagnosis. Materials and Methods: A total of 50 cases of sinonasal masses were included in this study. Written informed consent from the patients was obtained. Detailed clinical history and local and general examinations were done according to the pro forma attached with a special reference to the nose, PNSs, and oral cavity. These cases were subjected to after routine hematological and biochemical evaluation, nasal endoscopy, X-ray PNSs/computed tomography scan, fine-needle aspiration cytology, and, whenever required, biopsy. Results: On radiological assessment, of 50 patients, 45 patients were declared benign, while as 5 patients were diagnosed as having primary or secondary malignancy involving sino-NCs. Based on bone erosions along with internal hyperdense contents and enhancement pattern, there was some amount of discordance among radiological and histopathological diagnosis. One case which was diagnosed as malignancy (likely metastasis) was found to have invasive fungal sinusitis. Among the three radiologically diagnosed inverted papillomas (based on focal hyperostosis, subtle calcification, and cerebriform enhancement on postcontrast study), only 1 case correlated histopathologically. The rest were hemangioma and schwannoma (very rare). Radiological esthesioneuroblastoma, hemangioma, angiofibroma, and rhinolith correlated well with histopathology. Conclusion: Imaging plays an important role in the evaluation of sinonasal masses. Benign lesions are diagnosed very accurately. The distinction between sinonasal and invasive fungal sinusitis is still debatable, and hence, histopathological correlation is necessary. The presence of significant cervical lymphadenopathy can serve as a surrogate marker of malignancy.

Comparative utility of bone marrow aspiration and trephine biopsy in evaluation of hematological disorders Lekshmi Vijayamohanan, Sarita Asotra, Kavita Kumari, Pooja Murgai, Digvijay Dattal Archives of Medicine and Health Sciences 2020 8(1):15-19 Background: Bone marrow examination is a useful investigative tool to diagnose several hematological and nonhematological disorders. While the aspiration provides excellent cytological detail, the biopsy provides information regarding the spatial relationships of cells, marrow architecture, and valuable information when aspirate is nondiagnostic. We conducted this study to compare the diagnostic usefulness and comparison between aspirate and trephine biopsies in the evaluation of hematological disorders. Aim: The aim was to assess the relative efficacy of bone marrow aspiration and trephine biopsy and the overall diagnostic utility of this procedure in the diagnosis of hematological and nonhematological disorders. Materials and Methods: This is a retrospective study of 6-month duration at a tertiary care hospital in Himachal Pradesh. Patients were aged from 1 to 85 years. A total of 169 cases were studied, in whom bone marrow aspiration and trephine biopsy were performed, with special stains used where required. Results: A specific pathology was found in 89 cases(52.66%), rest being a normal or unsatisfactory study. Trephine biopsy was fundamental in the diagnosis in 69 cases(48.93%). Nearly 21.05% of the aspirates indicating a normal study further revealed a specific pathology on trephine biopsy and 38.88% of the unsatisfactory aspirates revealed definite pathology on biopsy. We noted that 8.87% of cases were diagnosed by trephine biopsy alone, with 89.94% concordance between trephine biopsy and aspiration. Conclusion: Bone marrow aspirate cytology and trephine biopsy are useful adjuncts to each other and should be used to supplement each other in arriving at a definite diagnosis, and they remain as a key diagnostic tool in hematological disorders.

Clinicohistopathologic study of lichenoid interface dermatitis Aparna Muralidhar, Suguna Belur Venugopal, AS Nandini Archives of Medicine and Health Sciences 2020 8(1):20-25 Background: Interface dermatitis (IFD)/lichenoid tissue reactions are among the most frequently presenting disorders in dermatology, which in common have a constellation of histopathological features but varied clinical presentation. Aim: Clinicopathologic correlation and determination of histomorphologic changes associated with various lichenoid IFD of the skin. Materials and Methods: This was a prospective study with purposive sampling of patients reporting to the outpatient department of dermatology, venerology, and leprosy of our hospital from January 2017 to July 2018. Skin biopsies of 150 patients of either sex diagnosed provisionally as one of the lichenoid IFD on clinical grounds were studied. Clinicohistopathologic correlation was done. Results: We encountered 58 cases of classic lichen planus, seven variants of lichen planus (hypertrophic lichen planus, ashy dermatosis, lichen planus pigmentosus, actinic lichen planus, lichen planopilaris, lichen nitidus, and lichen striatus), and 16 cases of lichenoid eruptions. About 82.6% of the cases were concordant histopathologically. The peak incidence was in 20–40 years of age with an equal predilection for males and females. A majority of the lesions were multiple, pruritic, papules, and plaques involving the limbs. Histopathologically, the most consistent findings were basal cell vacuolar degeneration followed by melanin incontinence. Conclusion: Lichenoid IFDs are exclusive clinicopathological entities with several variants. Subtle features noted on histopathology help in differentiating these lesions. Understanding and interpreting these subtle changes aids in better clinical management of the patient.

The effect of strength training of the calf muscle pump on cardiovascular parameters Andrew Lalchhuanawma, Divya Sanghi Archives of Medicine and Health Sciences 2020 8(1):26-30 Background: The heart pump allows blood to flow where the network of arteries, capillaries, and veins throughout the body regulates the rate of circulation of the blood. Parameters that determine the fitness level of the cardiovascular system include heart rate (HR), blood pressure (BP), VO2 max, fatigue, etc., The calf muscle pump is the most important of the lower limb, as it is the most efficient and has the largest capacitance. It has been suggested that increased leg strength, independent of cardiovascular training, may augment an aerobic endurance performance. Aim: The aim of this study is to determine the effect of strength training of gastrocnemius and soleus muscles on cardiovascular parameters. Materials and Methods: An experimental study carried out at MRIIRS Institution for 1 year. Forty-five recreational players aged between 20 and 30 years were selected after obtaining informed consent. Participants were divided equally into three groups by a convenient chit method. They were assessed for cardiovascular parameters of HR, BP, VO2 max, fatigue, and FI at baseline and after 8 weeks training program. Group A participated in gastrocnemius and soleus; Group B participated in gastrocnemius, and Group C participated in the soleus muscle training program. Results: Paired t-test for pre–post training shows a significant difference P < 0.05 for all the groups. ANOVA used between groups pre–post training were found to be significant for HR and systolic BP (SBP), and nonsignificant for diastolic BP (DBP) and VO2 max. Kruskal–Wallis test used between groups before and after training was found to be significant for fatigue and fitness index (FI). Jonckheere-trend test Post hoc analysis showed that Group A performed better than Group C and B. Wilcoxon signed-rank test for fatigue and FI showed a significant difference for all the groups. Conclusion: Eight weeks of leg muscle training on cardiovascular parameters have an effect on cardiovascular parameters of HR, SBP, FI, and fatigue. The results showed no significant effects on DBP and VO2 max.

Morphometric variations in sigmoid notch and condyle of the mandible: A retrospective forensic digital analysis in North Indian population Varsha Kanjani, Prashant Kalyani, Neha Patwa, Vaibhav Sharma Archives of Medicine and Health Sciences 2020 8(1):31-34 Introduction: The peculiarity of anatomical structures such as mandible, frontal sinus, sella turcica, nasal septum, and styloid process present in human skull and their variations leads to the revolution in forensic anthropology. The digitization in radiology enables a health professional to store the previous antemortem records and thereby compare it with postmortem records in case of mass disasters. Aim: The present retrospective analysis was conducted to evaluate the morphological variations in the sigmoid notch and condyles of the mandible and also to determine its peculiarity in establishing individual's identity. Materials and Methods: The study included 1200 panoramic radiographs of individuals in the age range of 10–60 years among population of Jodhpur, Rajasthan. The radiographs were taken using PLANMECA machine and enrolled radiographs were outlined using tracing tool installed in the software. The morphological variations of sigmoid notch and condyle in the panoramic radiographs were analyzed bilaterally for both males and females using Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: The sloping shape of the sigmoid notch was most commonly found (43%), followed by wide (37.66%) and round shape (19.25%). The most common shape of condyle observed was round (46.12%), followed by angled (29.29%), convex (21.95%), and flat shape (2.62%). The distribution of sigmoid notch and condylar shape variations among right and left sides was not statistically significant. Conclusion: In forensic anthropology, the morphological variations among sigmoid notch and condyle of mandible using single panoramic radiographic view can be used as an adjuvant for personal identification.

Expression of human epidermal growth factor receptor 2/neu in breast carcinoma: Experience from a tertiary care center in Tamil Nadu, India Syed Ahmed Hussain, S Prakashiny, Naseem Noorunnisa, R Revathi Shree, Senthil N Ganesh Archives of Medicine and Health Sciences 2020 8(1):35-40 Background and Aim: Women diagnosed with the foremost common cancer are the breast carcinoma. Human epidermal growth factor receptor 2 (HER2)/neu status has become an important part of immunohistochemical evaluation of breast carcinoma. Hence, the main aim of our study was to correlate the HER2/neu expression in breast carcinoma patients with certain clinicopathological parameters to ensure the better prognosis of the disease. Materials and Methods: The present study included 56 breast carcinoma patients. The surgically dissected breast carcinoma specimens were subjected to immunohistochemistry staining and were evaluated for certain clinicopathological prognostic parameters that included tumor size, Nottingham modification of the Scarff Bloom-Richardson (NSBR) grading, necrosis, lymph vascular invasion, fibrosis, stromal reaction, and lymph node metastasis. Statistical analysis by the Chi-square and Student's t-test was performed. Results: Most patients belonged to the postmenopausal age group (62.5%). Only 19 (33.9%) out of 56 patients showed positive for HER2/neu expression with maximum HER2/neu expression noted in the 40–60 years' (44.83%) age group. A greater proportion of cases (66.07%) had tumor size ranging from 2 to 5 cm with a majority of HER2/neu-positive (40.5%) cases among them. Majority of patients (96.24%) were of infiltrating ductal carcinoma. With respect to NSBR grading, 50% patients in Grade 3 showed positive HER2/neu expression (P = 0.048). It was also observed that 17 patients showed positive HER2/neu expression at the varying stages of lymph node metastasis (P = 0.022). Conclusion: The evaluation of HER2/neu expression indicates it to be a stronger prediction of poor prognosis due to its association with prognostic parameters.

Total antioxidant/oxidant status in chronic periodontitis patients with type II diabetes following nonsurgical periodontal therapy Ruby Ramya Vincent, Devapriya Appukuttan, Aruna Balasundaram, Vanaja Krishna Naik, Dhayanand John Victor Archives of Medicine and Health Sciences 2020 8(1):41-46 Background: Diabetes and periodontitis are chronic inflammatory diseases characterized by a dysregulated inflammatory response involving oxidative stress (OS). Nonsurgical periodontal therapy (NSPT) eliminates bacterial load followed by reduction in inflammatory burden due to reduced levels of proinflammatory mediators. Aim: The study aimed to evaluate the effect of NSPT on the OS biomarkers in the gingival crevicular fluid (GCF) of generalized chronic periodontitis (GCP) patients with Type II diabetes mellitus (DM). Materials and Methods: Eighty participants were allotted into Group I, systemically healthy with GCP (n = 20); Group II, GCP with Type II DM (n = 20); Group III, Type II DM without chronic periodontitis (CP) (n = 20); and Group IV, periodontally and systemically healthy controls (n = 20). Plaque index, gingival index (GI), probing pocket depth (PPD), and clinical attachment loss (CAL) were recorded. GCF was evaluated for total antioxidant capacity (TAOC), total oxidant status (TOS), and OS index (OSI). Patients in group I and II received NSPT. Results: Groups I, II, and III at baseline demonstrated significantly lower GCF TAOC and higher TOS and OSI when compared to Group IV (P < 0.001). GI in Group I at baseline negatively correlated with TAOC, whereas PPD and OSI were positively correlated (P < 0.05). Following NSPT, significant improvements were observed in the clinical parameters and in the TAOC levels in both group I and II patients (P < 0.001). In diabetics with GCP following NSPT, it was observed that OSI positively correlated (r = 0.46, P < 0.05) with CAL. In group I and II patients, TOS and OSI reduced significantly from baseline (P < 0.001). Conclusions: Based on the study results, we infer that NSPT can positively modulate the levels of OS biomarkers by restoring the oxidative imbalance. Further, the study underscores the role of periodontal therapy in decreasing oxidative burden in diabetics with periodontal disease.

Arbitrarily primed polymerase chain reaction-based identification of dystrophic onychomycosis Sandeep Kaur, Anu Gupta, Prabhjot Kaur Gill Archives of Medicine and Health Sciences 2020 8(1):47-52 Background and Objective: Onychomycosis is a fungal infection of the nails; when caused by dermatophytes, it is called as Tinea unguium. The aim was to explicate the utility of arbitrarily primed polymerase chain reaction (AP-PCR) to augment the early and accurate clinical diagnosis of dystrophic onychomycosis. Materials and Methods: The collected nail samples were divided into three portions. The first portion was explored for direct microscopic examination, the second portion was used for culturing of the nail samples on sabouraud dextrose agar media, and the third portion was used for DNA extraction followed by AP-PCR identification of dermatophytes. Results: All 48 samples with dystrophic onychomycosis were diagnosed by three methods, namely, 20% Potassium hydroxide microscopy, culture growth, and AP-PCR. With all the methods, Trichophyton rubrum was found as major causative agents for dermatophyte nail infection (60%), followed by Trichophyton mentagrophytes (23% cases). AP-PCR is a convenient method to achieve a higher dermatophyte identification rate with lesser time and shows complete concordance with conventional culture for two Trichophyton species. Conclusion: AP-PCR is a rapid, specific, and sensitive procedure for the diagnosis of nail fungal infection.