Tulika Joshi - Academia.edu (original) (raw)

Papers by Tulika Joshi

Journal of Fetal Medicine

To search out IUGR cases on the basis of clinical examination (symphysiofundal height) & to confi... more To search out IUGR cases on the basis of clinical examination (symphysiofundal height) & to confirm them with USG at 32 weeks of gestation. To validate Modified Biophysical Profile in all confirmed cases of IUGR from 32 weeks of gestation & all cases where AFI is decreased, NST is reactive & pregnancy is less than 36 weeks of gestation. To validate Complete Biophysical Profile & Color Doppler in cases: When pregnancy is less than 36 weeks of gestation & both NST & AFI are abnormal. STUDY DESIGN: prospective study carried out over 100 confirmed IUGR cases. MATERIALS AND METHODS: The IUGR cases were identified first by screening with SFH then confirmation with fetal abdominal circumference by USG at 32 weeks. All the cases were initially monitored with MBPP and BPP and color Doppler of Umbilical and MCA were performed in cases with abnormal MBPP having a non reactive NST. RESULTS: The incidence of IUGR was 3.86% in present study. The MBPP proved to be an effective tool for initial monitoring of IUGR cases with high specificity of 70.83%. The BPP and PI indices of Umbilical and middle cerebral arteries had good correlation with perinatal outcome i.e. BPP with sensitivity and PPV of 92.3% and 85.71%, Umbilical artery PI with sensitivity of 69.23% & positive predictive value of 90% and MCA PI with high specificity of 83.33% and PPV of 93.33%. CONCLUSION: MBPP is an effective initial surveillance tool in IUGR cases. The Biophysical profile, umbilical artery Doppler and Middle Cerebral artery Doppler have good correlation with perinatal outcome but further guidelines are required to integrate these surveillance modalities with each other.

Clinical Cancer Investigation Journal, 2014

Context : Oral cancer is the most common cancer in India and tongue is one of the most commonly a... more Context : Oral cancer is the most common cancer in India and tongue is one of the most commonly affected site. Aims and Objectives : The current study assesses the clinico-epidemiological trends of carcinoma tongue, its survival rates in different stages and relationship between different variables in central India. Materials and Methods : This was a retrospective study of 121 carcinoma tongue patients admitted between the period of 2½ years in a hospital of central India. The data collected were age and sex distribution, location and site of the tumor, tumor stage, histopathological type and grade, nodal status, modality of treatment, recurrences and survival. The disease free survival (DFS) was analyzed against stage, nodal status and recurrences using log rank test. Results : In this study, the incidence of cancer was more in males (male: female = 6.1:1) particularly in their fifth decade (mean 52.7 years) and the most common location was anterior 2/3 rd of the tongue mainly on right lateral side. Most of the patients presenting to out-patient department were having neck nodes positive status. The clinical stage at presentation was mainly advanced stages with well-differentiated squamous cell carcinoma. The most common treatment offered was surgery with radiotherapy (RT), followed by chemotherapy plus RT. The mean DFS time was of 27.8 ± 1.68 months, and it was directly related to tumor stage ( P Conclusion : The study signifies better prognosis of carcinoma tongue in early stages and warrants more awareness campaigns and health education in the health facilities as well as in community for early diagnosis of the disease with proper staging and subsequently multimodal treatment for increasing survival rates.

International Journal of Medical Science and Public Health, 2015

without any organic pathology. [3] The onset of primary dysmenorrhea is usually at or shortly aft... more without any organic pathology. [3] The onset of primary dysmenorrhea is usually at or shortly after menarche, when ovulatory cycles are established. Women with primary dysmenorrhea have a greater endometrial production of prostaglandins compared with asymptomatic women. [4] Primary dysmenorrhea is an important clinical cause in young girls for work absenteeism, thus having negative effect on QoL. The World Health Organization defined health as being not only the absence of disease and infirmity but also the presence of physical, mental, and social well-being. [5] QoL is defined as a subjective phenomenon based on individual perception, experiences, beliefs, and expectations. [6] Nowadays, QoL has become an issue in many clinical studies. [7] Severe dysmenorrhea pain is associated with restriction of activity and absence from school/college or workplace. Participation in usual activities is adversely affected in 5-20% of the women. [8] Pain poses a unique challenge for outcomes research because of the central importance of patientcentered and patient-reported information. The diagnosis may be overlooked, and the impact of primary dysmenorrhea has been poorly studied; mainly, the studies have focused on Western populations. [9]

American Journal of Medical Genetics, 1984

The multiple pterygium syndrome is consist of wide range of fetal malformations which have a gene... more The multiple pterygium syndrome is consist of wide range of fetal malformations which have a genetic linkage. A defect in embryonic acetylcholine receptor which can be inherited as autosomal recessive, autosomal dominant, or X-linked fashion is the cause of this syndrome. We present a sporadic case of lethal multiple pterygium syndrome.

Antenatal Fetal Surveillance in Iugr and Its Outcome, Apr 20, 2013

Background: Analysis of maternal near miss provides a good op portunity for assessing the factors... more Background: Analysis of maternal near miss provides a good op portunity for assessing the factors responsible for maternal mortality in this area. Objective: Incidence of maternal near miss and mortality cas es in central India tertiary care centre and evaluation of variou s causes using WHO criteria. Material and Methods: It is an ongoing prospective observational study conducted i n the department of Obstetrics and Gynaecology, Ind ex medical college, Indore, MP from September 2015 to October 2016. The patients who fulfilled the WHO cr iteria of maternal near miss were enrolled; their clinical and investigation parameters were recorded. Results: During the study period a total 4786 deliveries were obser ved, out of that 4533 were live births, 74 were nea r miss cases and 15 maternal deaths. Twenty nine (39.1%) of nea r miss cases were found in 15-20 year of age group while 53.33 % cases of maternal death were found of same age group. Primipara cases were more in both near m iss (6...

Background: Birth weight is an important indicator of a child′s vulnerability to the risk of chil... more Background: Birth weight is an important indicator of a child′s vulnerability to the risk of childhood illness and chances of survival. The identification of factors contributing to low birth weight (LBW) is therefore of paramount importance. Objective: The objective was to investigate effects of maternal factors on birth weight of the baby. Materials and Methods: In a cross-sectional hospital-based study, data collection was done on 100 women for their age at the time of delivery, gestational age (GA), parity, height, weight, hemoglobin, blood sugar, blood pressure, sex of the delivered child, and weight of the child during the period from June to August 2014. Descriptive statistics, bivariate analysis, receiver operative characteristic (ROC) curve, and logistic regression analysis were used. Results: The proportion of LBW (<2500 g) was found to be 36.8% in the infants. Anemia was seen in 67% of the women. Bivariate analysis showed that GA (r = 0.68) was significantly associated...

Journal of Family Medicine and Primary Care, 2015

Background: Dysmenorrhea is a common gynecological condition with painful menstrual cramps of ute... more Background: Dysmenorrhea is a common gynecological condition with painful menstrual cramps of uterine origin. Prevalence of primary dysmenorrhea is not yet clearly studied in central India. Objective: To study prevalence of primary dysmenorrhea in young girls and to evaluate associated clinical markers of dysmenorrhea. Materials and Methods: In a cross-sectional study, data was collected among 310 girls (18-25 years) on age at menarche, presence and absence of dysmenorrhea, dysmenorrhea duration, pre-menstrual symptoms (PMS), family history, menses irregularities, menstrual history, severity grading using visual analogue scale (VAS) using a semi-structured questionnaire. Results: Dysmenorrhea was reported in 84.2% (261) girls and 15.8% (49) reported no dysmenorrhea. Using VAS, 34.2% of girls experienced severe pain, 36.6% moderate and 29.2% had mild pain. Bleeding duration was found to be significantly associated with dysmenorrhea (χ 2 = 10.5; P < 0.05), girls with bleeding duration more than 5 days had 1.9 times more chance of getting dysmenorrhea (OR: 1.9; 95% CI: 1.7-3). Moreover, girls with the presence of clots had 2.07 times higher chance of having dysmenorrhea (OR: 2.07; 95% CI: 1.04-4.1) (P < 0.05). Almost 53.7% girls who had some family history of dysmenorrhea, 90.9% experience the condition themselves (χ 2 = 11.5; P < 0.001). Girls with family history of dysmenorrhea had three times greater chance of having the same problem (OR: 3.0; 95% CI: 1.5-5.8; P = 0.001). Conclusion: Dysmenorrhea is found to be highly prevalent among college going girls. Family history, bleeding duration and presence of clots were significant risk factors for dysmenorrhea.

Context : Oral cancer is the most common cancer in India and tongue is one of the most commonly a... more Context : Oral cancer is the most common cancer in India and tongue is one of the most commonly affected site. Aims and Objectives : The current study assesses the clinico-epidemiological trends of carcinoma tongue, its survival rates in different stages and relationship between different variables in central India. Materials and Methods : This was a retrospective study of 121 carcinoma tongue patients admitted between the period of 2½ years in a hospital of central India. The data collected were age and sex distribution, location and site of the tumor, tumor stage, histopathological type and grade, nodal status, modality of treatment, recurrences and survival. The disease free survival (DFS) was analyzed against stage, nodal status and recurrences using log rank test. Results : In this study, the incidence of cancer was more in males (male: female = 6.1:1) particularly in their fifth decade (mean 52.7 years) and the most common location was anterior 2/3 rd of the tongue mainly on right lateral side. Most of the patients presenting to out-patient department were having neck nodes positive status. The clinical stage at presentation was mainly advanced stages with well-differentiated squamous cell carcinoma. The most common treatment offered was surgery with radiotherapy (RT), followed by chemotherapy plus RT. The mean DFS time was of 27.8 ± 1.68 months, and it was directly related to tumor stage ( P Conclusion : The study signifies better prognosis of carcinoma tongue in early stages and warrants more awareness campaigns and health education in the health facilities as well as in community for early diagnosis of the disease with proper staging and subsequently multimodal treatment for increasing survival rates.

Aims and Objectives: To determine the correlation of antioxidant system and reactive oxygen speci... more Aims and Objectives: To determine the correlation of antioxidant system and reactive oxygen species with clinical parameters in infertile semen samples. Materials and Methods: Semen sample of fifty infertile men were divided into three groups: (1) Group I - Normospermic (count >15 million/ml), Group II - Asthenospermic (motility <32%), and Group III - Oligospermic (counts <15 million/ml) subjects based on the sperm count and sperm motility. The samples were also divided into two groups: (1) Group IV with semen pH >7.2 (25 samples) and Group V - Semen pH <7.2 (25 samples). The grouping was based on the WHO guideline for semen analysis (12). The semen antioxidant parameters like glucose-6-phosphate dehydrogenase (G-6-PDH) (spectrophotometric method Kornberg and Horecker, 1955). Catalase (Maehly and Chance 1954), glutathione peroxidase (GPX) (Rotruck method), glutathione (GSH) (dithiobisnitro-benzoate method), superoxide dismutase (SOD) (direct method), and malondialdehy...

Journal of natural science, biology, and medicine, 2015

We aimed to validate Mannheim peritonitis index (MPI) for prediction of outcome in patients with ... more We aimed to validate Mannheim peritonitis index (MPI) for prediction of outcome in patients with perforation peritonitis. A prospective study involving 100 subjects operated for perforation peritonitis over the period of 2 years was designed. Postevaluation of predesigned performa, MPI score was calculated and analyzed for each patient with death being the main outcome measure. The MPI scores were divided into three categories; scores <15 (category 1), 16-25 (category 2), and >25 (category 3). Our study consisted of 82 males and 18 females (male:female ratio 4.56:1), with the mean patients age of 37.96 ± 17.49 years. 47, 26, and 27 cases belonged to MPI score categories 1, 2, and 3, respectively. The most common origin of sepsis was ileal with small intestine dominating the source of perforation. When the individual parameters of MPI score were assessed against the mortality only, age >50 years (P = 0.015), organ failure (P = 0.0001), noncolonic origin of sepsis (P = 0.002)...

Journal of Fetal Medicine

To search out IUGR cases on the basis of clinical examination (symphysiofundal height) & to confi... more To search out IUGR cases on the basis of clinical examination (symphysiofundal height) & to confirm them with USG at 32 weeks of gestation. To validate Modified Biophysical Profile in all confirmed cases of IUGR from 32 weeks of gestation & all cases where AFI is decreased, NST is reactive & pregnancy is less than 36 weeks of gestation. To validate Complete Biophysical Profile & Color Doppler in cases: When pregnancy is less than 36 weeks of gestation & both NST & AFI are abnormal. STUDY DESIGN: prospective study carried out over 100 confirmed IUGR cases. MATERIALS AND METHODS: The IUGR cases were identified first by screening with SFH then confirmation with fetal abdominal circumference by USG at 32 weeks. All the cases were initially monitored with MBPP and BPP and color Doppler of Umbilical and MCA were performed in cases with abnormal MBPP having a non reactive NST. RESULTS: The incidence of IUGR was 3.86% in present study. The MBPP proved to be an effective tool for initial monitoring of IUGR cases with high specificity of 70.83%. The BPP and PI indices of Umbilical and middle cerebral arteries had good correlation with perinatal outcome i.e. BPP with sensitivity and PPV of 92.3% and 85.71%, Umbilical artery PI with sensitivity of 69.23% & positive predictive value of 90% and MCA PI with high specificity of 83.33% and PPV of 93.33%. CONCLUSION: MBPP is an effective initial surveillance tool in IUGR cases. The Biophysical profile, umbilical artery Doppler and Middle Cerebral artery Doppler have good correlation with perinatal outcome but further guidelines are required to integrate these surveillance modalities with each other.

Clinical Cancer Investigation Journal, 2014

Context : Oral cancer is the most common cancer in India and tongue is one of the most commonly a... more Context : Oral cancer is the most common cancer in India and tongue is one of the most commonly affected site. Aims and Objectives : The current study assesses the clinico-epidemiological trends of carcinoma tongue, its survival rates in different stages and relationship between different variables in central India. Materials and Methods : This was a retrospective study of 121 carcinoma tongue patients admitted between the period of 2½ years in a hospital of central India. The data collected were age and sex distribution, location and site of the tumor, tumor stage, histopathological type and grade, nodal status, modality of treatment, recurrences and survival. The disease free survival (DFS) was analyzed against stage, nodal status and recurrences using log rank test. Results : In this study, the incidence of cancer was more in males (male: female = 6.1:1) particularly in their fifth decade (mean 52.7 years) and the most common location was anterior 2/3 rd of the tongue mainly on right lateral side. Most of the patients presenting to out-patient department were having neck nodes positive status. The clinical stage at presentation was mainly advanced stages with well-differentiated squamous cell carcinoma. The most common treatment offered was surgery with radiotherapy (RT), followed by chemotherapy plus RT. The mean DFS time was of 27.8 ± 1.68 months, and it was directly related to tumor stage ( P Conclusion : The study signifies better prognosis of carcinoma tongue in early stages and warrants more awareness campaigns and health education in the health facilities as well as in community for early diagnosis of the disease with proper staging and subsequently multimodal treatment for increasing survival rates.

International Journal of Medical Science and Public Health, 2015

without any organic pathology. [3] The onset of primary dysmenorrhea is usually at or shortly aft... more without any organic pathology. [3] The onset of primary dysmenorrhea is usually at or shortly after menarche, when ovulatory cycles are established. Women with primary dysmenorrhea have a greater endometrial production of prostaglandins compared with asymptomatic women. [4] Primary dysmenorrhea is an important clinical cause in young girls for work absenteeism, thus having negative effect on QoL. The World Health Organization defined health as being not only the absence of disease and infirmity but also the presence of physical, mental, and social well-being. [5] QoL is defined as a subjective phenomenon based on individual perception, experiences, beliefs, and expectations. [6] Nowadays, QoL has become an issue in many clinical studies. [7] Severe dysmenorrhea pain is associated with restriction of activity and absence from school/college or workplace. Participation in usual activities is adversely affected in 5-20% of the women. [8] Pain poses a unique challenge for outcomes research because of the central importance of patientcentered and patient-reported information. The diagnosis may be overlooked, and the impact of primary dysmenorrhea has been poorly studied; mainly, the studies have focused on Western populations. [9]

American Journal of Medical Genetics, 1984

The multiple pterygium syndrome is consist of wide range of fetal malformations which have a gene... more The multiple pterygium syndrome is consist of wide range of fetal malformations which have a genetic linkage. A defect in embryonic acetylcholine receptor which can be inherited as autosomal recessive, autosomal dominant, or X-linked fashion is the cause of this syndrome. We present a sporadic case of lethal multiple pterygium syndrome.

Antenatal Fetal Surveillance in Iugr and Its Outcome, Apr 20, 2013

Background: Analysis of maternal near miss provides a good op portunity for assessing the factors... more Background: Analysis of maternal near miss provides a good op portunity for assessing the factors responsible for maternal mortality in this area. Objective: Incidence of maternal near miss and mortality cas es in central India tertiary care centre and evaluation of variou s causes using WHO criteria. Material and Methods: It is an ongoing prospective observational study conducted i n the department of Obstetrics and Gynaecology, Ind ex medical college, Indore, MP from September 2015 to October 2016. The patients who fulfilled the WHO cr iteria of maternal near miss were enrolled; their clinical and investigation parameters were recorded. Results: During the study period a total 4786 deliveries were obser ved, out of that 4533 were live births, 74 were nea r miss cases and 15 maternal deaths. Twenty nine (39.1%) of nea r miss cases were found in 15-20 year of age group while 53.33 % cases of maternal death were found of same age group. Primipara cases were more in both near m iss (6...

Background: Birth weight is an important indicator of a child′s vulnerability to the risk of chil... more Background: Birth weight is an important indicator of a child′s vulnerability to the risk of childhood illness and chances of survival. The identification of factors contributing to low birth weight (LBW) is therefore of paramount importance. Objective: The objective was to investigate effects of maternal factors on birth weight of the baby. Materials and Methods: In a cross-sectional hospital-based study, data collection was done on 100 women for their age at the time of delivery, gestational age (GA), parity, height, weight, hemoglobin, blood sugar, blood pressure, sex of the delivered child, and weight of the child during the period from June to August 2014. Descriptive statistics, bivariate analysis, receiver operative characteristic (ROC) curve, and logistic regression analysis were used. Results: The proportion of LBW (<2500 g) was found to be 36.8% in the infants. Anemia was seen in 67% of the women. Bivariate analysis showed that GA (r = 0.68) was significantly associated...

Journal of Family Medicine and Primary Care, 2015

Background: Dysmenorrhea is a common gynecological condition with painful menstrual cramps of ute... more Background: Dysmenorrhea is a common gynecological condition with painful menstrual cramps of uterine origin. Prevalence of primary dysmenorrhea is not yet clearly studied in central India. Objective: To study prevalence of primary dysmenorrhea in young girls and to evaluate associated clinical markers of dysmenorrhea. Materials and Methods: In a cross-sectional study, data was collected among 310 girls (18-25 years) on age at menarche, presence and absence of dysmenorrhea, dysmenorrhea duration, pre-menstrual symptoms (PMS), family history, menses irregularities, menstrual history, severity grading using visual analogue scale (VAS) using a semi-structured questionnaire. Results: Dysmenorrhea was reported in 84.2% (261) girls and 15.8% (49) reported no dysmenorrhea. Using VAS, 34.2% of girls experienced severe pain, 36.6% moderate and 29.2% had mild pain. Bleeding duration was found to be significantly associated with dysmenorrhea (χ 2 = 10.5; P < 0.05), girls with bleeding duration more than 5 days had 1.9 times more chance of getting dysmenorrhea (OR: 1.9; 95% CI: 1.7-3). Moreover, girls with the presence of clots had 2.07 times higher chance of having dysmenorrhea (OR: 2.07; 95% CI: 1.04-4.1) (P < 0.05). Almost 53.7% girls who had some family history of dysmenorrhea, 90.9% experience the condition themselves (χ 2 = 11.5; P < 0.001). Girls with family history of dysmenorrhea had three times greater chance of having the same problem (OR: 3.0; 95% CI: 1.5-5.8; P = 0.001). Conclusion: Dysmenorrhea is found to be highly prevalent among college going girls. Family history, bleeding duration and presence of clots were significant risk factors for dysmenorrhea.

Context : Oral cancer is the most common cancer in India and tongue is one of the most commonly a... more Context : Oral cancer is the most common cancer in India and tongue is one of the most commonly affected site. Aims and Objectives : The current study assesses the clinico-epidemiological trends of carcinoma tongue, its survival rates in different stages and relationship between different variables in central India. Materials and Methods : This was a retrospective study of 121 carcinoma tongue patients admitted between the period of 2½ years in a hospital of central India. The data collected were age and sex distribution, location and site of the tumor, tumor stage, histopathological type and grade, nodal status, modality of treatment, recurrences and survival. The disease free survival (DFS) was analyzed against stage, nodal status and recurrences using log rank test. Results : In this study, the incidence of cancer was more in males (male: female = 6.1:1) particularly in their fifth decade (mean 52.7 years) and the most common location was anterior 2/3 rd of the tongue mainly on right lateral side. Most of the patients presenting to out-patient department were having neck nodes positive status. The clinical stage at presentation was mainly advanced stages with well-differentiated squamous cell carcinoma. The most common treatment offered was surgery with radiotherapy (RT), followed by chemotherapy plus RT. The mean DFS time was of 27.8 ± 1.68 months, and it was directly related to tumor stage ( P Conclusion : The study signifies better prognosis of carcinoma tongue in early stages and warrants more awareness campaigns and health education in the health facilities as well as in community for early diagnosis of the disease with proper staging and subsequently multimodal treatment for increasing survival rates.

Aims and Objectives: To determine the correlation of antioxidant system and reactive oxygen speci... more Aims and Objectives: To determine the correlation of antioxidant system and reactive oxygen species with clinical parameters in infertile semen samples. Materials and Methods: Semen sample of fifty infertile men were divided into three groups: (1) Group I - Normospermic (count >15 million/ml), Group II - Asthenospermic (motility <32%), and Group III - Oligospermic (counts <15 million/ml) subjects based on the sperm count and sperm motility. The samples were also divided into two groups: (1) Group IV with semen pH >7.2 (25 samples) and Group V - Semen pH <7.2 (25 samples). The grouping was based on the WHO guideline for semen analysis (12). The semen antioxidant parameters like glucose-6-phosphate dehydrogenase (G-6-PDH) (spectrophotometric method Kornberg and Horecker, 1955). Catalase (Maehly and Chance 1954), glutathione peroxidase (GPX) (Rotruck method), glutathione (GSH) (dithiobisnitro-benzoate method), superoxide dismutase (SOD) (direct method), and malondialdehy...

Journal of natural science, biology, and medicine, 2015

We aimed to validate Mannheim peritonitis index (MPI) for prediction of outcome in patients with ... more We aimed to validate Mannheim peritonitis index (MPI) for prediction of outcome in patients with perforation peritonitis. A prospective study involving 100 subjects operated for perforation peritonitis over the period of 2 years was designed. Postevaluation of predesigned performa, MPI score was calculated and analyzed for each patient with death being the main outcome measure. The MPI scores were divided into three categories; scores <15 (category 1), 16-25 (category 2), and >25 (category 3). Our study consisted of 82 males and 18 females (male:female ratio 4.56:1), with the mean patients age of 37.96 ± 17.49 years. 47, 26, and 27 cases belonged to MPI score categories 1, 2, and 3, respectively. The most common origin of sepsis was ileal with small intestine dominating the source of perforation. When the individual parameters of MPI score were assessed against the mortality only, age >50 years (P = 0.015), organ failure (P = 0.0001), noncolonic origin of sepsis (P = 0.002)...