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   Table of Contents - Current issue
Coverpage
July-September 2020
Volume 32 | Issue 3
Page Nos. 223-304

Online since Wednesday, July 1, 2020

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REVIEW ARTICLE - BASIC  

Is there a role for oxidative stress and mitochondrial dysfunction in age-associated bladder disorders? p. 223
Lori A Birder
DOI:10.4103/tcmj.tcmj_250_19  
Millions of individuals worldwide are affected by age-related lower urinary tract symptoms (LUTSs), including impaired detrusor contractility, detrusor overactivity, decreased bladder sensation, as well as increased bladder capacity often resulting in incomplete bladder emptying. Yet, the underlying factors that contribute to these symptoms are not known and there are few therapies to treat these disorders. Because of the complex pathophysiology, a number of animal models have been studied over the years to better understand mechanisms underlying patient symptoms. Such animal models can aid in the investigation of aspects of age-associated LUTSs that cannot be pursued in humans as well as to develop and test potential therapies. In addition, the search for urinary factors that may be a causative agent has resulted in the discovery of a number of potential targets that could serve as predictive biomarkers which can aid in early diagnosis and treatment of these chronic disorders. Recent evidence has supported a role for chronic changes in mitochondrial function and oxidative stress (along with production of reactive oxygen species) and abnormal urodynamic behavior in older patients. This review discusses new insights into how aging alters fundamental cellular processes that impair signaling in the bladder wall, resulting in abnormal voiding function.
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REVIEW ARTICLES - CLINICAL Top

Reemergence of dengue virus in Bangladesh: Current fatality and the required knowledge p. 227
Rashed Noor
DOI:10.4103/tcmj.tcmj_193_19  
The current fatality of dengue among the Bangladeshi population has drawn the interest of the public health professionals primarily to focus on the environmental, social, and clinical reasoning as well the possible remedies. This year, in 2019, the dengue situation in Bangladesh has appeared with all its dreadful effects leading to the highest death cases due to dengue virus (DENV) infection. According to the Directorate General of Health Services report, this year (2019) the number of DENV-infected people has appeared to be around five times higher (approximately 50,000 cases so far) compared with the last year, 2018 (around 10,000 cases). The present review discussed the current epidemics of dengue infection in Bangladesh as well the possible means of disease curing in terms of general preventive concepts. However, besides the precise treatment of the dengue-affected patients, the knowledge on DENV genome and on the protective immunity against such reemerging disease is essential.
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Association of bone mineral density and trabecular bone score with cardiovascular disease p. 234
Tzyy-Ling Chuang, Mei-Hua Chuang, Malcolm Koo, Chun-Hung Lin, Yuh-Feng Wang
DOI:10.4103/tcmj.tcmj_234_19  
Traditionally, osteoporosis and cardiovascular disease (CVD) are considered as separate chronic diseases. Increasing evidence now links osteoporosis with hypertension, abnormal lipid metabolism, atherosclerosis, vascular calcification (VC), and congestive heart failure. VC coexists with bone loss, and aortic calcification is a strong predictor of low bone mineral density (BMD) and fragility fractures. The same holds true for coronary artery calcification (CAC): the lower the BMD, the higher the CAC. Trabecular bone score (TBS) iNsight software can analyze the existing BMD database to obtain the bony microstructure score (TBS). Many TBS-related studies include fracture risk, normal aging, diabetes, potential genes, obesity, and asthma severity prediction. The inverse relationship of TBS to VC may provide insight into bone–vascular interactions in chronic kidney disease. A higher TBS has been associated with moderate, but not high, CAC. One explanation is that bone microstructural remodeling becomes more active during early coronary calcification. Increased risk of 10-year likelihood of hip fracture and major osteoporotic fracture as estimated by the fracture risk assessment tool FRAX® is significantly and independently associated with more severe CAC scores. Dual-energy X-ray absorptiometry and FRAX® can be used to predict fracture risk and CAC scores, identifying patients who may benefit from early intervention. This review will discuss the relationship and possible mechanism of BMD, TBS, and FRAX® with CVD and VC or CAC.
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REVIEW ARTICLE - MEDICAL ETHICS Top

Insight into modern-day plagiarism: The science of pseudo research p. 240
Hunny Sharma, Swati Verma
DOI:10.4103/tcmj.tcmj_210_19  
In today's world, when there is a rapid surge of biomedical publications, maintaining research integrity of articles is of prime importance. It is expected that the submitted work is genuine of submitting authors'. Ease in the availability of these digitally published biomedical papers and pressure to publish for academic and professional advancement had resulted in numerous novice scientists and students falling into unethical practice of plagiarizing others' work to get the job done quickly. Plagiarists are continuously in search of finding new and easy ways to plagiarize someone else's work, currently seen as different forms of plagiarism. Hence, this narrative review intends to help young and upcoming researchers to understand plagiarism, its type, the reason for plagiarists getting involved in that, and possible ways to detect and prevent it.
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ORIGINAL ARTICLES - BASIC RESEARCH Top

Targeting of interleukin-10 receptor by a potential human interleukin-10 peptide efficiently blocks interleukin-10 pathway-dependent cell proliferation p. 245
Chun-Chun Chang, Cheng-Der Liu, Sheng-Feng Pan, Wei-Han Huang, Chih-Wen Peng, Hao-Jen Hsu
DOI:10.4103/tcmj.tcmj_237_19  
Objective: Human interleukin-10 (IL-10) is a dimeric and pleiotropic cytokine that plays a crucial role in cellular immunoregulatory responses. As IL-10 binds to its receptors, IL-10Ra and IL-10Rb, it will suppress or induce the downstream cellular immune responses to protect from diseases. Materials and Methods: In this study, a potential peptide derived from IL-10 based on molecular docking and structural analysis was designed and validated by a series of cell assays to block IL-10 binding to receptor IL-10Ra for the inhibition of cell growth. Results: The simulation results indicate that the designed peptide IL10NM25 bound to receptor IL-10Ra is dominated by electrostatic interactions, whereas van der Waals (VDW) and hydrophobic interactions are minor. The cell experiments showed that IL10NM25 specifically binds to receptor IL-10Ra on the cell surface of two B-lineage cell lines, B lymphoma derived (BJAB), and lymphoblastoid cell line, whereas the mutant and scramble peptides are not able to suppress the binding of IL-10 to receptor IL-10Ra, consistent with the molecular simulation predictions. Conclusion: This study demonstrates that structure-based peptide design can be effective in the development of peptide drug discovery.
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The deduced probable HLA-C*03:187-associated human leukocyte antigen haplotype (A*24:02-B*35:01-C*03:187-DRB1*11:01) revealed in Taiwanese unrelated hematopoietic bone marrow stem cell donors p. 254
Kuo-Liang Yang, Py-Yu Lin
DOI:10.4103/tcmj.tcmj_106_19  
Objective: HLA-C*03:187 is a rare frequency allele in the human leukocyte antigen (HLA)-C locus. The purpose of this investigation is to indicate the ethnicity of C*03:187 and its deduced plausible HLA haplotype in association in Taiwanese unrelated bone marrow stem cell donors. Materials and Methods: A DNA sequence-based typing procedure was used to verify the rare frequency allele C*03:187. Employing group-specific primer sets' polymerase chain reaction was carried out to amplify exons 2 and 3 of HLA-A locus, HLA-B locus, exon 1 to exon 7 of the HLA-C locus, and exon 2 of the HLA-DRB1 locus. The amplified gene products were sequenced employing the BigDye® Terminator Cycle Sequencing Ready Reaction kits in both directions according to the manufacturer's instructions. Results: The DNA sequence of C*03:187 is identical to C*03:03:01:01 from exon 1 to exon 7, except for codon 152 of exon 3 where GAG of C*03:03:01:01 is replaced by GTG in C*03:187. The nucleotide replacement causes one amino acid change to the protein sequence of C*03:03:01:01 at position 152 where glutamic acid (E) is changed to a valine (V) in C*03:187. The deduced plausible HLA haplotype in association with C*03:187 in Taiwanese is as A*24:02-B*35:01-C*03:187-DRB1*11:01. Conclusion: The data on the deduced plausible HLA haplotype in association with the low-frequency C*03:187 allele that we described in this report are valuable for immunogenetics laboratories for reference purposes. In addition, they can be utilized by search coordinators in hematopoietic stem cell transplant programs to determine a strategy for locating compatible donors in unrelated bone marrow donor registries for a patient with this unusual HLA allele.
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ORIGINAL ARTICLES - CLINICAL RESEARCH Top

A comparative study to evaluate oral iron and intravenous iron sucrose for treatment of anemia in pregnancy in a poor socioeconomic region of Northeast India p. 258
Maureen P Tigga, Amulya P Debbarma
DOI:10.4103/tcmj.tcmj_99_19  
Objective: The prevalence of anemia during pregnancy is as high as 80% in some sections of the Indian population. Iron therapy in different forms has been found to alleviate anemia and yield good fetomaternal outcome. This study aims to evaluate the efficacy of intravenous iron sucrose (IVIS) versus oral iron in treating anemia among the antenatal mothers attending a tertiary care center of Northeast India. Materials and Methods: One hundred women between 18 and 28 weeks of gestation with diagnosed iron-deficiency anemia and hemoglobin (Hb) of 7–10.9 g/dL were enrolled to be administered either oral ferrous sulfate 200 mg twice daily or requisite dose of IVIS 100 mg in 100 ml normal saline on alternate days. Hb and hematocrit were measured at the time of enrollment, 4th week, and 8th week of therapy. Acceptability of both the drugs based on like and dislike after interviewing the study participants was recorded. Adverse drug reactions, gestational age at delivery, and neonatal birth weight were also noted in both the groups. The results were analyzed by Student's t-test and Chi-square test. Results: Hb and hematocrit values were found to be increased in both the groups at 4th and 8th weeks. When both the groups were compared, the rise in the values was higher in the iron sucrose group (at 4th week P = 0.01 and at 8th week P = 0.00). The number of participants who reached target Hb levels at 4 weeks was 41 (82%) with oral iron and 48 (96%) with iron sucrose. In the iron sucrose group, no adverse effects were observed, suggesting its safety, and the acceptability and newborn birth weight were noted to be higher. Conclusion: IVIS was found to be more effective than oral iron therapy in treating antenatal anemia with no serious adverse drug reactions.
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Outcomes of laparoscopic hysteropexy and supracervical hysterectomy plus cervicopexy: A retrospective study p. 262
Pei-Chen Li, Dah-Ching Ding
DOI:10.4103/tcmj.tcmj_131_19  
Objectives: The objective of this study is to compare the outcomes of laparoscopic hysteropexy (LHP) and laparoscopic supracervical hysterectomy plus cervicopexy (LSHCP) for the treatment of pelvic organ prolapse (POP). Materials and Methods: We retrospectively included patients who had undergone laparoscopic sacral hysteropexy or hysterectomy plus cervicopexy between January 2015 and May 2019 at Hualien Tzu Chi Hospital, Taiwan. Age at surgery, body mass index (BMI) at admission, the initial stage of genital prolapse, operative and postoperative data, and anatomical results were recorded. Cure for uterine prolapse was evaluated objectively through vaginal examinations using the POP quantification scale. Visual analog scale (VAS) scores were recorded at 24 h postoperatively. The Mann–Whitney U-test was used to compare continuous variables. Results: A total of 23 women were included in the study; 12 had received LHP (n = 12) and 11 had received LSHCP (n = 11). No differences existed in age, parity, BMI, blood loss, or hospital stay between groups. The difference in mean surgical times between the LHP and LSHCP groups was nonsignificant (154 and 176 min, respectively;P = 0.2). VAS scores were significantly lower in the LSHCP group than in the LHP group (0.1 vs. 1.75; P = 0.004). Furthermore, mean hospital stay was significantly longer in the LSHCP group than in the LHP group (4.0 vs. 3.1 days; P = 0.016). The procedure was successful in 100% of patients (23 of 23), with no objective evidence of uterine prolapse on examination at follow-up at 6 months. Conclusion: LHP had a significantly shorter hospital stay and a higher VAS score than LSHCP. LHP and LSHCP are both feasible and effective procedures for correcting uterine prolapse.
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Prevalence and correlates of antenatal depression among women registered at antenatal clinic in North India p. 267
Neha Dahiya, Kavita Aggarwal, Rajesh Kumar
DOI:10.4103/tcmj.tcmj_97_19  
Objective: Women pass through many stages throughout her lifetime. Among these phases, pregnancy is crucial phase. If women are not able to cope with this stress, it may lead to adverse outcomes of pregnancy. Early detection of possible depression in pregnant women may lead to decrease in incidence of depression and adverse outcomes of pregnancy. Materials and Methods: The present study was done in an urban primary health center of east Delhi where antenatal and postnatal services are provided. Two hundred pregnant women who attended antenatal clinic for their antenatal checkup were included in the study. Edinburgh postnatal depression scale was used to diagnose possible depression. The presence of a statistically significant difference between possibility of depression in terms of various socioeconomic, obstetric, gender issues, life events, previous psychiatric history and family relationships was ascertained using Chi-square/Fisher's exact test. Logistic regression was carried out to determine important confounding variables. Results: The mean age of participants was 25.32 ± 3.86 years. Of total 200 women, 42 (21%) women were found to be suffering from possible depression. The possibility of depression was found to be significantly higher in literate participants (P = 0.001) and in women who were married after 18 years of age (P = 0.016). Participants who wanted the present pregnancy and whose spouses were alcoholic were found to be associated significantly (P = 0.00). On applying logistic regression, age and abortion history was found to be significant. Conclusion: This study demonstrates that the prevalence of antenatal depression is high in developing countries, and universal screening of depression during antenatal and postnatal period is feasible along with other antenatal and postnatal services provided to them.
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Low serum adiponectin level is associated with central arterial stiffness in patients undergoing peritoneal dialysis p. 272
Ti-Kang Chen, Yu-Chien Pan, Chih-Hsien Wang, Jia-Sian Hou, Bang-Gee Hsu
DOI:10.4103/tcmj.tcmj_67_19  
Objective: Adiponectin has antidiabetic, anti-atherosclerotic, and anti-inflammatory functions and protects against vascular damage. Carotid-femoral pulse wave velocity (cfPWV) is a noninvasive method for measuring central artery stiffness, which is known to be associated with cardiovascular disease in peritoneal dialysis (PD) patients. This study was conducted to evaluate the relationship between central arterial stiffness and serum adiponectin levels in PD patients. Materials and Methods: Fasting blood samples were obtained from 60 PD patients, and the cfPWV value was measured using a validated tonometry system. In this study, cfPWV values of >10 m/s were used to define the high arterial stiffness group according to the European Society of Hypertension and the European Society of Cardiology guidelines. Results: Among 60 patients with PD, 19 patients (31.7%) were included in the high arterial stiffness group. When compared to those in the control group, the high arterial stiffness group patients were older (P = 0.029), had longer PD vintage (P = 0.001), higher diastolic blood pressures (P = 0.030), higher fasting glucose (P = 0.014), and lower serum adiponectin levels (P = 0.001). After multivariable logistic regression analysis, serum adiponectin (odds ratio, 0.612; 95% confidence interval: 0.426–0.879; P= 0.008) was identified as an independent predictor of arterial stiffness. The multivariable regression analysis also showed that the adiponectin level (β = −0.408; adjusted R2 change = 0.183; P< 0.001) was negatively associated with cfPWV values in patients undergoing PD. Conclusion: Low serum adiponectin level is an independent marker of arterial stiffness in patients undergoing PD.
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Effect of hospice care on health-care costs for Taiwanese patients with cancer during their last month of life in 2004–2011: A trend analysis p. 278
Jui-Kun Chiang, Yee-Hsin Kao
DOI:10.4103/tcmj.tcmj_90_19  
Objective: End-of-life cancer care imposes a heavy financial burden on patients, their families, and their health insurers. The aim of this study was to explore the 8-year (2004–2011) trends in health-care costs for Taiwanese cancer decedents in their last month of life and, specifically, to assess the association of these trends with hospice care. Materials and Methods: We conducted a population-based longitudinal study and analyzed data from Taiwan's National Health Insurance Research Database. The data consisted of not only claims information – costs of hospitalization and outpatient department visits – but also the associated patient characteristics, catastrophic illness status, hospice patient designation, and insurance system exit date (the proxy for death). Results: A total of 11,104 cancer decedents were enrolled, and 2144 (19.3%) of these patients received hospice care. The rate of hospice service use increased from 14.9% to 21.5% over 8 years. From 2004 to 2011, the mean health-care cost per day in the last month of life increased 8.2% (from US$93 ± $108 in 2004 to US$101 ± $110 in 2011;P= 0001). We compared three groups of patients who received hospice care for more than 1 month (long-H group), received hospice care for 30 days or less (short-H group), and did not receive hospice care (non-H group). Compared to non-H group, long-H group had a significantly lower mean health-care cost per day during their last month of life (US$85.7 ± 57.3 vs. US$102.4 ± 120) (P < 0001). Furthermore, compared to short-H and non-H groups, patients in the long-H group had lower probabilities of receiving chemotherapy and visiting the emergency department more than once. They also incurred lower health-care costs (US$77.1 ± 58.1 vs. US$92.2 ± 56.0 for short-H group and US$102.4 ± 120 for non-H group) (P < 0001). Conclusion: Health-care costs in the last month of life are increasing over time in Taiwan. Nonetheless, health-care costs for patients receiving hospice can be as much as 16.3% lower than patients not receiving hospice care. Patients receiving hospice care for more than 30 days also had lower health-care costs than those receiving care for <30 days.
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Comparison of surgical outcome between conventional open thyroidectomy and endoscopic thyroidectomy through axillo-breast approach p. 286
Kian-Hwee Chong, Ming-Hsun Wu, Chieh-Wen Lai
DOI:10.4103/tcmj.tcmj_109_19  
Objective: Minimally invasive thyroidectomy can be categorized into either video-assisted method or remote access thyroidectomy (RAT). Although RAT provided excellent cosmetic results, some debate about the advantages and disadvantages remains in different countries. Thus, this study aimed to compare the surgical results between endoscopic thyroid surgery and conventional thyroidectomy. Materials and Methods: The study retrospectively reviewed the conventional and endoscopic thyroidectomy performed at our institution from September 2011 to July 2012. Overall, 30 patients were recruited for this study. The patients were divided into two groups: Group O (open group, n = 15) and Group E (endoscopic group, n = 15). Postoperative outcomes (including wound pain, swallowing disturbance, and chest wall paresthesia) and complications were analyzed and assessed. Results: The endoscopic group was associated with longer operation time and hospital stay. The visual analog scale (VAS) score of surgical wound pain was significantly higher in the open group in 1-week postoperation. However, the VAS score of swallowing disturbance was significantly higher in the endoscopic group in 1-week postoperation. More than half of the patients (53%) had chest wall paresthesia within 1-month postoperation in the endoscopic group. No surgical complications occurred in both groups. Conclusion: Although endoscopic thyroidectomy provides excellent cosmetic results in thyroid surgery, higher immediate postoperative pain, and prolonged chest wall paresthesia compared with those in conventional surgery are a concern and warrant careful patient selection.
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ORIGINAL ARTICLE - MEDICAL EDUCATION Top

Fostering 2nd-year medical students' reflective capacity: A biopsychosocial model course p. 291
Hsuan Hung, Ling-Ling Kueh, Jun-Neng Roan, Jing-Jane Tsai
DOI:10.4103/tcmj.tcmj_65_19  
Objective: The biopsychosocial (BPS) model has been proposed to take into account the interaction of psychological and social factors in medical practice. Although some studies have explored its application in medical education, little has been evaluated about students' reflection in such courses. This study introduced a BPS model course and aimed to assess changes in students' reflective capacity resulting from this course. Materials and Methods: Eighty-seven written reflections before and after the course were segmented, coded, and rated using the Reflection Evaluation for Learners' Enhanced Competencies Tool rubric, which contains six factors of reflective capacity, namely description of disease experience, presence, attending to emotions, description of conflict or disorienting dilemma, meaning making, and action. Results: After the BPS model course, the overall reflective capacity, as well as the “Presence” and “Meaning making” scores, increased, while scores for “Attending to emotion” decreased significantly. “Description of disease experience,” “Description of conflict or disorienting dilemma,” and “Action” showed no significant change. Conclusion: Pedagogical suggestions are discussed for a BPS model course with reflective training for young medical students.
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CASE REPORTS Top

Disastrous delayed postpartum hemorrhage after 3 days of Shenghua decoction treatment p. 298
Hui-Hua Chen, Yueh-Hung Chou, Ho-Hsiung Lin, Sheng-Mou Hsiao
DOI:10.4103/tcmj.tcmj_192_19  
Taiwanese women frequently receive Shenghua decoction treatment for uterus involution. However, prolonged Shenghua decoction treatment can be detrimental. Herein, we report the case of a woman with disastrous postpartum hemorrhage after prolonged Shenghua decoction treatment. A 36-year-old woman underwent scheduled cesarean delivery due to cephalopelvic disproportion. On the 8th postpartum day, she started taking Shenghua decoction twice per day. Massive vaginal bleeding was noted after 3 days of Shenghua decoction treatment. Emergency hysterectomy was performed due to severe hypotension and refractory postpartum hemorrhage. Despite being rare, disastrous delayed postpartum hemorrhage could occur after 3 days of Shenghua decoction treatment. Further research might be needed to clarify the relationship between prolonged Shenghua decoction treatment and delayed postpartum hemorrhage.
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Resection of a cavernous hemangioma of the posterior mediastinum by sclerotherapy and uniport thoracoscopic surgery p. 301
Jin-You Jhan, Yi-Tso Cheng, Jui-Chih Cheng, Bing-Ru Chung, Nai-Wei Huang, Bee-Song Chang
DOI:10.4103/tcmj.tcmj_168_19  
A 44-year-old female presented with cavernous hemangioma of the posterior mediastinum. Imaging revealed that it was approximately 2 cm in size and without an arterial supply from either the thoracic aorta or intercostal artery. The patient was treated with intraoperative sclerotherapy and hemangioma resection by uniport thoracoscopic surgery via a small 3-cm surgical wound. The surgical outcome and follow-up were good.
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IMAGES IN CLINICAL MEDICINE Top

Dancing pharynx p. 303
Yew Toong Liew, Andrew Charles Gomez Junior, Adzreil Bakri, Prepageran Narayanan
DOI:10.4103/tcmj.tcmj_245_19  
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