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  Most popular articles (Since September 08, 2016)

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Oral antidiabetic agents: Recently available novel oral antidiabetic agents in India: Aclinical review
Nitin Kapoor, Nihal Thomas
July-September 2017, 15(3):169-176
Oral anti-diabetic agents form an important therapeutic strategy in the management of diabetes, after lifestyle modification. There are several new agents available, like dipeptidyl peptidase 4 (DPP4) inhibitors and sodium- glucose cotransporter 2 (SGLT2) inhibitors have been approved for use as monotherapy when diet and exercise are inadequate and when metformin is not tolerated, and can also be utilized as an add on to other glucose-lowering agents, including insulin. The therapeutic, pharmacokinetic and safety profiles of these agents are different from the older agents. Hydroxychloroquine (hcq) and bromocriptine have been recently cleared for use and show beneficial effects in control of blood glucose and HbA1C levels.
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Clinical features and diagnosis of autism spectrum disorder in children
Susan Mary Zachariah, Samuel Philip Oommen, Beena Koshy
January-March 2017, 15(1):6-16
Autism spectrum disorder (ASD) is a neurodevelopmental disorder of behavior that presents in childhood. It is a clinically heterogeneous disorder of behavior, characterized by two features - (1) impairment in social communication and interaction and (2) repetitive patterns of behavior. The diagnosis is essentially clinical and is based primarily on history-taking and observation of the child over a period. There are several standardized screening tools and scales available to help make a diagnosis. Children with autism often present with speech delay and this has to be distinguished from other conditions. ASD is often associated with comorbid conditions which have to be identified to tailor the treatment program for each child. It is important that the parents or caretakers of the child are involved in the process of assessment and diagnosis and that their misconceptions and fears are addressed.
  6,885 8 1
Early use of intravenous N-acetylcysteine in treatment of acute yellow phosphorus poisoning
Meban Aibor Kharkongor, Ajay Kumar Mishra, K Fibi Ninan, Ramya Iyadurai
April-June 2017, 15(2):136-138
Rodenticides remain an important cause of morbidity and mortality among patients with deliberate self-harm. Yellow phosphorus is an important class of rodenticide due to its high toxic nature and is associated with a high mortality rate. The absence of any specific antidote is an important factor for poor prognosis among those who consume this poison. We report a case of acute liver injury secondary to yellow phosphorus poisoning which was successfully managed with intravenous N-acetylcysteine.
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Clinical case scenarios in the management of diabetes mellitus
Sahana Shetty, Nitin Kapoor, Nihal Thomas
July-September 2017, 15(3):186-188
  5,149 8 -
Bedside ultrasound of the abdomen - Part 1
Sudha Kiran Das
October-December 2016, 14(4):113-120
Ultrasound of the abdomen is a commonly requested investigative procedure. By the use of different probes and varying maneuvers, a remarkable range of views can be obtained. Imaging of the liver is done using four views which can identify most pathological conditions. Being aware of the possible artifacts helps in avoiding a wrong diagnosis. Gallbladder (GB) imaging is useful in detecting gallstones and inflammation of the GB. When inflamed, the pancreas enlarges in size and is bulky, with peripancreatic fluid, which is suggestive of acute pancreatitis.
  4,606 9 -
National Accreditation Board for Hospitals and Healthcare Providers (NABH) Standards: A review
Samuel N. J. David, Sonia Valas
July-September 2017, 15(3):231-236
Quality has become an important buzzword for the current generation of healthcare providers. Most hospitals and healthcare providers are differentiated and evaluated according to their organization performance and quality.National Accreditation Board for Hospitals and Healthcare Providers(NABH) is an integral board of Quality Council of India, established to operate accreditation program for healthcare organizations/institutions. Accreditation is a public recognition awarded to healthcare organizations which fulfill the standards laid by NABH through an independent external assessment conducted by qualified team of assessors.
  4,024 7 -
Dengue illness in children
Winsley Rose, J Ebor Jacob, Debasis Das Adhikari, Valsan Philip Verghese
April-June 2017, 15(2):95-105
Dengue fever is often a self-limiting illness of viral origin and is transmitted by mosquitoes. Children, especially those under 2 years of age and those with comorbid illnesses are particularly vulnerable. A small percentage of individuals with the infection may develop features of severe dengue (SD) which is potentially life threatening. Warning signs often precede the development of SD. The recognition of symptoms of SD fever and optimal fluid management are key factors in the treatment of this illness.
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Polycystic ovarian syndrome: Treatment options for infertility
Sumi Thomas, S Sudharshini
October-December 2016, 14(4):87-93
Polycystic ovarian syndrome (PCOS) is a common cause of infertility and is characterized by clinical features of irregular menstrual cycles, hirsutism, and anovulatory infertility. The diagnosis is made based on the presence of two of three features (oligo/anovulation, hyperandrogenism, and polycystic ovaries on transvaginal ultrasound) according to the Rotterdam diagnostic criteria. Lifestyle modifications to reduce weight and the use of ovulation induction medications form the cornerstone of treatment of anovulatory infertility secondary to PCOS. Clomiphene citrate is the most effective as an agent for ovulation induction. The other therapeutic options include laparoscopic ovarian drilling, ovulation induction with gonadotropins, and in vitro fertilization.
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Management of intrauterine growth restriction
Liji S David, Anne George Cherian, Manisha Madhai Beck
October-December 2017, 15(4):271-277
Intrauterine growth restriction (IUGR) is a condition where the fetus does not attain its biologically determined growth potential due to a pathological process. The main tools for antenatal surveillance in a growth-restricted fetus include amniotic fluid volume, Doppler studies, and biophysical profile. The frequency of surveillance depends on the severity of the growth restriction and the findings on previous ultrasound studies. The decision to deliver the fetus is dependent on factors such as gestational age, severity of growth restriction, and findings on the Doppler studies. If there is severe abnormality in the Doppler studies, lower segment cesarean section is recommended as the mode of delivery. Vaginal delivery may be attempted after induction of labor if Doppler parameters are normal, in a center with adequate facilities for monitoring facilities and when there are personnel with expertise. This review provides an overview of antenatal monitoring in a pregnancy with IUGR and decision-making during the time of delivery.
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Diet in a pregnant mother with diabetes mellitus
Mini Joseph, Sahana Shetty, Nihal Thomas
July-September 2017, 15(3):222-226
Gestational diabetes mellitus(GDM) is a severe threat to maternal and child health. It is associated complications adversely affect the mother and the child. One in seven births is affected by gestational diabetes. Lifestyle intervention has a positive impact on glycemic control and pregnancy outcomes of GDM. Adequate nutrition during pregnancy ensures good health for the mother and the growing fetus. There is an increased need for calories, proteins and vitamins, and minerals to meet the demands of increased metabolic activity during this period. The composition of each meal is crucial in attaining glycemic control. Alow-carbohydrate diet(60%–65%) with adequate proteins(15%) and fats(20%–25%) is beneficial in attaining acceptable postprandial sugars. “My Plate Planner” is a simple method for remembering the type and quantity of food to be consumed with each meal. Regularity of meals with frequent snacking of healthy foods ensures acceptable glucose homeostasis throughout the day.
  3,256 7 -
Management of autism spectrum disorder: A case-based overview
Samuel Philip Oommen, Suman Bhattacharyya, Beena Koshy, Reeba Roshan, Lincy Samuel, R Preethi
January-March 2017, 15(1):17-27
The management of autism spectrum disorder requires a multidisciplinary team (MDT) comprising parents, therapists, psychologists, special educators, and medical specialists. Therapy is aimed at helping the child acquire functional skills in daily living, to minimize the core features of autism, and eliminate behaviors that are unhelpful or disruptive. The child must be adequately assessed by every member of the MDT to formulate an intervention plan which is then brought together to tailor a specific treatment plan for each child. The involvement of the parents or caretakers in the entire process is critical. The plan should address multiple areas such as communication, social skills, behavior, daily living, motor skills, and learning early and intensive treatment has been shown to be much more effective than treatment that is delayed. The child's progress should be monitored and documented, and only then can the intervention model's effectiveness be gauged.
  3,053 7 -
Theodor Schwann: A founding father of biology and medicine
Tony Abraham Thomas
October-December 2017, 15(4):299-301
Theodor Schwann is best remembered for the eponymous Schwann cell that he studied and described in his microscopic studies of nervous tissue. However, his most important contribution to science would be the fact that he was one of the founders of the 'Cell doctrine' which proposed that all living beings were made of fundamental units called cells - a foundational principle on which rests much of our understanding of biological science. Schwann was one of the first scientists to break away from vitalism to lean toward a mechanistic or physico-chemical explanation of living processes which proposed that the biological processes in cells and living beings could be explained by physical and chemical phenomena. He was also involved in describing the physiology of bile and the enzyme pepsin which furthered our understanding of the physiology of digestion. His contributions to biology and medicine has paved the way for the emergence and blooming of several fields of study such as microbiology, pathology, histology and the principle of antibiotics.
  3,021 7 -
Risk assessment of intrauterine growth restriction
Reeta Vijayaselvi, Anne George Cherian
October-December 2017, 15(4):262-266
Intrauterine growth restriction is a condition where the estimated fetal weight is less than the 10th percentile on ultrasound and the fetus has not attained its biologically determined growth potential because of a pathologic process. This review deals with the definitions of fetal growth restriction, the etiology associated with it, the types of fetal growth restriction and discusses how to differentiate between them. The various screening mechanisms available, the approach to a patient who is at risk for fetal growth restriction and whether they will benefit from any of the prophylactic measures available are also discussed.
  2,953 8 1
Approach to diabetic neuropathy
Nitin Kapoor, Kirubah David, Bharathy Saravanan
July-September 2017, 15(3):189-199
Neuropathy is the most common symptomatic complication of diabetes mellitus(DM) and accounts for a large share of morbidity and hospitalization associated with the disease. The symptoms of neuropathy in diabetes may present with somatic, autonomic, motor or sensory symptoms. Symmetric distal sensory polyneuropathy is the most common form, affecting the distal lower extremities and hands in a “glove and stocking” pattern. Cardiac autonomic neuropathy can, in particular, contribute to 6% of sudden deaths(painless myocardial infarction) among those with long-standing diabetes. Neuropathy whether sensory, motor, or autonomic may lead to the formation of fissures or calluses which lead to ulceration. Tight glycemic control is the only strategy which has demonstrated to show prevention and progress of diabetic peripheral neuropathy and autonomic neuropathy. Early treatment of diabetic neuropathy should, therefore, include tight glycemic control. All patients should be screened for diabetic neuropathy starting at diagnosis of type2 DM and 5years after diagnosis of type1 DM and at least annually thereafter. An annual comprehensive foot examination is a must for all patients with diabetes and consists of examination of foot and footwear, neuropathy screening, vascular assessment, and musculoskeletal assessment of feet. This would help in identification of risk factor predictive of ulcers and amputation.
  2,847 7 -
Diagnosing pulmonary tuberculosis in children
Valsan Philip Verghese
April-June 2017, 15(2):106-113
Children account for about 5% of new TB cases in India but this may be an underestimate, as clinical signs of TB are subtle in children. Pulmonary TB is the most common form in children but diagnosis is challenging due to various factors including difficulty in collecting specimens from young children who tend to swallow sputum and produce fewer TB bacilli in specimens compared to adults. Tests such as the AFB smear used in adults are therefore often negative in children. A high index of suspicion needs to be maintained in order to make the diagnosis. Symptoms such as persistent fever and non-remitting cough are highly specific for a diagnosis of TB. The chest radiograph is the most important investigation for making an early diagnosis of in pediatric pulmonary TB. When starting empiric anti-tuberculous therapy in children, it is essential to monitor the treatment response in the form of resolution of symptoms and gain in weight. A poor clinical response to treatment should alert one to the possibility of poor adherence to therapy, incorrect doses of antituberculous drugs, presence of TB resistant to first-line drugs or an incorrect diagnosis of tuberculosis in the first place.
  2,807 7 -
Dr. Mary Verghese: Wheelchair surgeon and pioneer of physical medicine and rehabilitation in India
Raji Thomas
April-June 2017, 15(2):148-152
The history of Physical Medicine and Rehabilitation (PM&R) in India is intertwined with the personal story of Dr. Mary Verghese. The tragedy of a road traffic accident that rendered her paraplegic inspired her to establish a department of PM&R in Vellore and a Rehabilitation Institute, the first of its kind in the country. The Rehabilitation Institute which she pioneered is today one of the premier institutes for the rehabilitation of people with disabilities and stands as a testimony to the transforming power of her faith and resilience.
  2,801 7 -
Unexplained infertility: An approach to diagnosis and management
Mohan S Kamath, Mogili Krishna Deepti
October-December 2016, 14(4):94-100
The cause of infertility is said to be unexplained when there is normal ovulatory function, semen analysis is normal, and tubal patency is established by hysterosalpingography or laparoscopy. Some of the factors that may contribute to the etiology of unexplained infertility are inability to identify the subtle reproductive abnormalities, endocrine/genetic/immunological disorders, minimal/mild endometriosis, and compromised ovarian and natural fecundability that may be less than normal. Prognostic factors in unexplained infertility include maternal age, duration of infertility, and previous obstetric history. The management options depend on various factors such as age of woman, duration of infertility, couples' preferences, and the health-care setting. The options available for treatment include expectant management, clomiphene citrate, super ovulation with intrauterine insemination, and in vitro fertilization/intracytoplasmic sperm injection.
  2,592 10 1
Death certificate and death intimation
D Samuel Abraham
July-September 2017, 15(3):247-248
  2,416 7 -
Scrub typhus in children
Winsley Rose
April-June 2017, 15(2):90-94
Scrub typhus is a mite-borne acute febrile illness caused by Orientia tsutsugamushi, and is transmitted by the bite of the trombiculid mite. It presents with high-grade fever which may be associated with nonspecific signs and symptoms such as rash, muscle and abdominal pain, headache, and lymph node enlargement. Scrub typhus is, therefore, one of the differential diagnoses to be considered in a child with acute undifferentiated febrile illness, especially if the disease is endemic to the region. The presence of a painless eschar at the site of the bite is an important pointer to the diagnosis. The illness responds well to antibiotics, usually within 48 h.
  2,415 7 -
Practical use of insulin in diabetes mellitus
Sahana Shetty, Ruth Daniel, Nihal Thomas
July-September 2017, 15(3):177-185
Insulin therapy is the cornerstone of treatment in patients with type1 diabetes mellitus(DM) and advanced type2 DM. Over the years, insulin treatment has advanced from animal insulin to recombinant insulin with more efficiency and fewer side effects and from short-acting conventional insulin to ultrashort and long-acting insulin analogs to mimic various phases of physiological insulin secretion. Various insulin delivery systems from conventional subcutaneous insulin injection using insulin syringe to pen device, subcutaneous insulin infusion pumps, and inhaled insulin to artificial pancreas are now available. Proper insulin injecting techniques and patient education on self-monitoring of blood glucose and insulin dose titration are of utmost importance for effective insulin therapy.
  2,191 8 -
Interpretation of thyroid function tests
Mathews Edatharayil Kurian, Nitin Kapoor
April-June 2018, 16(2):34-38
Thyroid function tests are one of the most common endocrine panels in general practice because a good understanding of when to order them, interpretation of their results and indications for treatment are important for the optimal treatment of thyroid dysfunction. Thyroid-stimulating hormone (TSH) should be the first test to be performed on any patient with suspected thyroid dysfunction and in follow-up of individuals on treatment. It is useful as a first-line test because even small changes in thyroid function are sufficient to cause a significant increase in TSH secretion. Thyroxine levels may be assessed in a patient with hyperthyroidism, to determine the severity of hyperthyroxinemia. Antithyroid peroxidase measurements should be considered while evaluating patients with subclinical hypothyroidism and can facilitate the identification of autoimmune thyroiditis during the evaluation of nodular thyroid disease. The measurement of TSH receptor antibody must be considered when confirmation of Graves' disease is needed and radioactive iodine uptake cannot be done.
  2,104 9 -
Subclinical hypothyroidism
K Felix Jebasingh, Dukhabandhu Naik, Nihal Thomas
April-June 2018, 16(2):39-41
Subclinical hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone level with a normal total and free thyroxine (T4) level. There is a certain degree of debate regarding the risks associated with this condition and whether treatment is beneficial. Individuals with SCH are either asymptomatic or present with milder symptoms than those with overt hypothyroidism. Although SCH does not cause significant clinical abnormalities, there are certain long-term consequences which have been documented. The diagnosis is based purely on biochemical investigations. Treatment of this condition is not indicated in all cases since thyroid function tests tend to normalize in 6%–35% of patients. However, there are specific clinical indications for treatment and oral levothyroxine is the treatment of choice in such situations.
  1,875 7 -
Management of hypoglycemia
Nitin Kapoor, Jubbin Jagan, Nihal Thomas
July-September 2017, 15(3):211-215
Hypoglycemia is a condition characterized by an abnormally low level of blood glucose and has significant clinical consequences if left untreated. It is a potential adverse event in the treatment of diabetes mellitus. Causes of hypoglycemia are varied, but in diabetic patients, it is most often iatrogenic. Medication changes or overdoses, infection, dietary changes, and changes in activity levels are some of the important reasons for a person to develop hypoglycemia. Prompt diagnosis and treatment of hypoglycemia is an essential component of the management of diabetes. Evaluation of the cause is important, especially if there are recurrent episodes of hypoglycemia.
  1,688 7 -
Diagnosis of intrauterine growth restriction
Anne George Cherian
October-December 2017, 15(4):267-270
Fetal growth restriction is an adverse event in pregnancy, and the goal of antenatal monitoring is early detection of intrauterine growth restriction (IUGR). This involves the correct determination of gestational age to differentiate fetal growth restriction from a perceived restriction due to the wrong estimation of the gestational age. The use of ultrasound studies to estimate fetal size, growth, and volume of liquor along with simple charting of fetal growth can help diagnose IUGR and guide the physician toward remedial measures. This review discusses clinical examination as well as investigations needed to confirm the diagnosis of fetal growth restriction.
  1,662 8 -
Zinc supplementation in diarrhea: Summary of cochrane database review
Tony Abraham Thomas
April-June 2017, 15(2):142-143
  1,644 7 -