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   Table of Contents - Current issue
July-December 2021
Volume 26 | Issue 2
Page Nos. 77-139

Online since Thursday, February 10, 2022

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Disruptive change in medical education during the COVID-19 pandemic: Challenges and opportunities Highly accessed article p. 77
Medha Anant Joshi, Mathangi Damal Chandrasekar
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Tuberculosis notification: Facilitators and barriers among private practitioners in Trichy, South India p. 81
Prabha Thangaraj, Kumarasamy Hemalatha
Context: The framework for tuberculosis (TB) notification is one of the components of the World Health Organization's End TB strategy. Notification is essential for estimating the true burden of TB and its control in community which is currently lacking in the private health sector. Aims: The objectives are to identify awareness, willingness, barriers, and preferred methods of TB notification among private practitioners (PPs) in Trichy, South India. Methods: A descriptive cross-sectional study was conducted among 152 doctors working in the private sector and having at least 1 year of clinical experience using nonprobability sampling. A semi-structured, pretested questionnaire was used to obtain details about the general profile, awareness, and willingness regarding TB notification, as well as factors that facilitate and hinder it. Results: Among PPs, 90.7% referred TB cases/suspects to other health facilities and 71.7% were aware that TB notification is mandatory. Only 52.6% and 38.2% were ready to provide the patients' Aadhaar number and bank account details respectively during notification. The most common barriers for notification were: not being aware about the notification procedure (50.7%), lack of time (32.2%), process being tedious (29.6%) and difficulties in getting information from patients (25.7%). Mobile SMS/App/call (74.3%) were preferred by PPs over notification through online (32.2%) and government health staff (26.3%). Conclusions: Although three-fourth of the practitioners were aware and willing to notify TB, more than half of them were not aware about the notification procedure. Improving the awareness on the techniques for notification could motivate PPs to notify TB.
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Animal bites presenting to the emergency department: Spectrum, seasonal variation, and outcome p. 86
Kundavaram Paul Prabhakar Abhilash, Rayshna Rao
Context: Animal bites including insect, reptile, and mammalian bites are common presentations to the emergency department (ED). Although profile and outcome of individual bites are described in detail, the literature on comprehensive overall clinical spectrum and seasonal variation of all animal bites is scant. Aims: To describe the spectrum, seasonal variation, clinical features, and outcomes of all patients presenting as emergencies due to animal bites. Methods: All the patients who presented to the ED of a large tertiary care hospital in South India with bites from January 2017 to December 2018 were retrospectively included in the analysis. Results: During the 2-year study period, animal bites constituted 0.83% of all ED admissions with 1145 incidents included in our analysis. The various animal bites/stings were classified as follows: mammal bites (480: 41.9%), arthropod bites (275: 24%), reptile bites (290: 25.3%), and unknown bites (100: 8.6%). We found an increase in the incidence of bites during the monsoon months of July to September (average: 58 cases per month) in our geographical locality. More than half (46: 58%) of scorpion stings had features of envenomation while a quarter (19: 24%) had the signs of autonomic storm. Snake bites constituted a quarter (25.2%: 289/1145) of all animal bites with 66% (191/289) showing features of envenomation. Dog bites constituted the majority of mammalian bites with 73% (352/480), followed by rat bites (14%: 68/480), cat bites (7.5%: 37/480), human bites (2.5%: 12/480), and monkey bites (1.9%: 9/480). The World Health Organization rabies exposure Category 3 bites were seen in 48%, 12%, and 27% of dog, rat, and cat bites, respectively. Conclusion: Snake and dog bites comprised the majority of all animal bites. There was a clear seasonal pattern with increased prevalence of bites during the rainy season.
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Mild cognitive impairment and its lifestyle-related risk factors in the elderly: A community-based cross-sectional study p. 92
Anku Moni Saikia, Vinoth Rajendran
Context: Alzheimer's dementia (AD), an irreversible condition is an important cause of disability in old age. Mild cognitive impairment (MCI) is an intermediate state between normal cognition and dementia. Amnestic MCI (aMCI) is the precursor of AD. Identification of modifiable lifestyle risk factors help in the prevention of aMCI, and thereby in the prevention of AD. Aim: The purpose of this study was to determine the prevalence of aMCI and different lifestyle factors associated with types of MCI. Methods: This cross-sectional study was conducted amongst the elderly (≥60 years). A sample of 576 persons was selected using a multistage sampling technique. Vernacular adaptation of Hindi Mini-Mental State Examination tool was used to screen dementia and MCI. Geriatric Depression Scale-15 was used for screening depression. Data were collected using a pre-designed and pretested schedule and SPSS was used for data entry and analysis. Results: The prevalence of MCI was found to be 22.4% among the elderly. Out of all MCI cases, the prevalence of aMCI was 38.8% in this study. The lack of social and leisure engagement was found to be significantly associated with the type of MCI. Conclusion: The comparatively higher prevalence of aMCI is just the tip of the iceberg. Lack of social and leisure engagement is a highly predictive risk factor.
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Association of Down syndrome with major congenital anomalies in the North Indian population p. 98
Kanchan Bisht, Rakesh Kumar Verma, Navneet Kumar, Shakal Narayan Singh, Baibhav Bhandari
Context: Down syndrome (DS), which usually occurs due to an extra chromosome 21 or a partial trisomy, is the most common genetic cause of intellectual disability. The affected individuals usually present with characteristic clinical manifestations and are seen to be associated with various systemic defects. Aim: The aim of our study was to determine the major congenital anomalies associated with DS in the North Indian population. Methods: Blood samples of 51 children (0–10 years) who were screened for the suspicion of DS were collected. Karyotyping was conducted. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: Out of the 51 suspected participants, karyotypes could be successfully obtained only for 40. Among these 40 participants, karyotypes of 35 were confirmed to be DS. Of these 35 confirmed cases, 21 (60%) were found to be associated with at least one major congenital anomaly, of which cardiac anomalies (34.2%) were most common, followed by gastrointestinal tract and genitourinary anomalies (11.4% each). Central nervous system and musculoskeletal anomalies constituted 5.7% each. Mosaic variant of DS was found to be least associated with congenital anomalies. Conclusion: The patients with DS should be carefully examined for systemic anomalies. Most cases are usually associated with at least one congenital anomaly.
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Evaluation of human epidermal growth factor receptor 2 expression in colorectal cancer and its correlation with clinicopathological variables p. 103
Sana Ahuja, Vinod Kumar Arora
Context: Colorectal cancer is the third most common cancer in men and the second most common cancer in women worldwide. Overexpression of human epidermal growth factor receptor 2 (HER2) in breast and gastric cancer is associated with poor prognosis. However, in colorectal cancer, there are no specific guidelines for immunohistochemical interpretation of HER2. Furthermore, there are conflicting reports regarding correlation of clinicopathological parameters with HER2 expression. Aim: The present study was conducted to determine the frequency of HER2 expression in colorectal cancer and its correlation with clinicopathological variables, if any. Methods: Resection specimens for colorectal cancer over a 2-year period were included in this retrospective study. HER2 immunostaining was done using a monoclonal antibody followed by evaluation of pattern and intensity of staining along with correlation of cells with membranous positivity. Clinicopathological parameters such as age, gender, tumor location, histological subtype of tumor along with tumor stage and grade were analyzed using Fisher's exact test for significance. Results: Of the 50 cases analyzed, 70%, 28%, and 2% were conventional, mucinous, and signet cell ring adenocarcinomas, respectively. The majority were moderately differentiated (56%) and most of the cases presented at Stage III. Weak-to-moderate cytoplasmic positivity was seen in 18% cases, while one case each (2%) showed combined cytoplasmic-membranous and complete membranous positivity, respectively. No significant correlation could be established between HER2 immunostaining and histological subtype or tumor stage/grade. Conclusions: Colorectal cancer demonstrates a very low membranous positivity to HER2 immunostaining. HER2 expression in colorectal cancer has no correlation with clinicopathological variables such as tumor grade, stage, and histological subtype. HER2 does not appear to have any prognostic role to play in colorectal cancer in the context of Indian population.
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Evaluation of ureterorenoscopy with semirigid ureteroscope and laser lithotripsy as a treatment modality for upper ureteric stones less than 20 mm p. 108
Ravi Batra, Pooja Batra, Shreyak Garg, Sneha Yadav
Context: Technological developments over the past two decades have revolutionized the treatment of ureteric stones. With the emergence of flexible, small-diameter ureteroscopy, the paradigm of ureteral stone treatment has shifted to ureteroscopy. The success rate is close to 95%, but it has its own complications. Objective: The objective of this study is to assess the effectiveness of ureterorenoscopy (URS) with semirigid ureteroscope and laser lithotripsy in the treatment of upper ureteric stones of size less than 20 mm and its associated complications. Methods: This is a prospective cohort study designed to assess the effectiveness of URS for the treatment of upper ureteric calculi. We present data from 57 patients who received URS as their primary treatment at our center and were followed up for at least 3 months. Results: We found that when stone size was less than 10 mm, the stone-free rate was 80% (28/35), while when stone size was in the 10.1–20 mm range, the stone-free rate increased to 90.9% (20/22). Stones were found in 41/48 patients (85.41%) with symptoms lasting less than a month. Only 7/9 patients (77.77%) were stone-free in the group with symptoms lasting more than a month. A total of 28.1% of patients encountered complications among which proximal migration of the stone was the most common (12.3%). Mean procedure time was 40.37 min. Conclusion: This study shows that URS had a higher stone-free rate when treating stones of size ranging from 10.1 to 20 mm. In upper ureteric stones ranging in size from 10.1 to 20 mm, we strongly advise using URS as the primary treatment option.
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Effect of pedometer-based walking on depression, anxiety, and insomnia among medical students in a government medical college p. 112
Shivangi Sharma, Meenu Rani, Sanjay Jain, Lokendra Sharma
Context: Pedometer is a popular tool to measure physical activity and it is easy to use. Objectives: The impact of pedometer-based walking on insomnia, anxiety, and depression among medical students was evaluated in this study. Methods: A total of 120 2nd-year MBBS students were randomly assigned to two groups (n = 60 in each group). Anxiety, insomnia, and depression levels were assessed using Beck's depression inventory, Beck's anxiety inventory, and Likert sleep scale questionnaire at different time durations. Data were analyzed using the independent t-test, Chi-square, and repeated measures tests. Results: We noticed 22.1% reduction in depression score in the intervention group (P = 0.009). Anxiety score was reduced to 19% among the intervention group students (P = 0.03). Sleep quality improved in students of the intervention group as compared to the control group (P < 0.001). Conclusion: A walking training programme can be considered to manage depression, anxiety, and insomnia in medical students.
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Audit of blood utilization in a tertiary care hospital: Our experience over a period of 2 years p. 118
Urmi Chakravarty-Vartak, Amrita Neelakantan, Shailesh Vartak, Rohini Shewale
Context: Blood transfusion plays a vital role in saving lives. However, owing to its many side effects, it should be used judiciously. Aim: The aims of this study were: audit of blood utilization in our tertiary care set up, formulation of a maximum surgical blood ordering schedule (MSBOS) for procedures where a complete cross-match appears mandatory, and improvement in the efficiency of blood utilization in trauma care. Methods: All patients admitted to Lokmanya Tilak Municipal Medical College and General Hospital during the study period for whom cross-match requests were sent to blood bank were included in this study. They were divided into groups according to the departments under which they were admitted. Data were analyzed and cross-match to transfusion ratio (C/T ratio), transfusion index, and transfusion probability (%T) were calculated. C/T ratio was used as an index of the efficacy of blood ordering practice, and a ratio of >2.5 was considered an indication of the excess cross match. Results: The maximum C/T ratio of 34.11 was noted in the Department of Cardiology. Only three departments (Artificial Kidney Dialysis, Pediatrics, and Medical Intensive Care Unit) showed effective utilization of blood. Minimum C/T ratio of 1.34 observed in the Department of Artificial Kidney Dialysis. Conclusion: We found gross over-ordering of blood by different departments. Hence we propose the formulation of a blood ordering schedule. We drafted a MSBOS which provides guidelines for frequently performed elective surgical procedures by recommending the maximum number of units of blood to be cross-matched preoperatively, implementation of which will result in more efficient use of blood.
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Treatment failure in malaria: Causes and complexities p. 122
Arvind Nath
Treatment failure in malaria is a major dilemma that health-care workers face throughout the country. True drug resistance is one of the causes after ruling out compliance and drug quality issues; the other causes being re-infection with a new strain of the parasite during the treatment period or, in the case of Plasmodium vivax, the release of hypnozoites from the liver. Since it is difficult, in the field, to identify the cause as being due to re-infection with a new strain of the parasite during the treatment period or, in the case of P. vivax, the release of hypnozoites from the liver, providing antimalarials to overcome drug resistance is the mainstay of therapy.
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Glandular odontogenic cyst mimickers: A review and report of two cases p. 124
Shruti Narendra Vichare, Srivalli Natarajan, Padmakar Sudhakar Baviskar, Suraj Arjun Ahuja, Pradeep Pandurang Vathare
Glandular odontogenic cyst (GOC) is a rare odontogenic cyst with a high recurrence rate. It is also associated with other odontogenic cysts and tumours. Odontogenic cysts with some histopathological features of GOC are termed as GOC mimickers (GOC-M). The diagnosis of a mimicker is challenging due to the lack of distinctive clinical and radiological features. Diagnosis is confirmed exclusively on histopathology. Specific guidelines based on histopathological features exist to recognize and delineate these mimickers from GOC. These features may be evident on incisional biopsy presenting an incorrect diagnosis of GOC leading to an erroneous overtreatment. On the contrary, overlooking these features in an incisional biopsy may result in misdiagnosis and under-treatment which increases the patient susceptibility to recurrence. This article reviews the enigmatic nature of GOC-M and presents two rare cases of the same in dentigerous cysts of the impacted supernumerary teeth in the anterior maxilla.
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Glandular odontogenic cyst: A case report of an unusual lesion p. 129
Nandhini Gunasekaran, Rajkumar Krishnan, Rema Krishnan
Glandular odontogenic cyst (GOC) is a rare cyst occurring in the jaw bone having an uncertain and aggressive behavior with high recurrence rate. The diagnosis of this lesion is trying as it can be confused with other jaw cysts and malignant lesions. Treatment methods vary from conservative surgical treatment to jaw resection. This article presents a case of GOC mimicking radiographically as a lateral periodontal cyst.
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Penetrating injury to the floor of mouth in a child: Management of a challenging case p. 132
Manas R Dash, Sworupa Nanda Mallick, K Rajinder Mishra, Pranay Panigrahi
Penetrating injuries of the oro-maxillofacial region are not only rare but difficult to manage in the pediatric age group. We report a case of a six-year-old girl who was injured with a penetrating reinforcing bar (rebar) in the floor of the mouth, where both ends of the rebar protruded out. The girl fell off a partially constructed terrace and was hanging with the rebar in her neck for hours. On examination, the vital structures of the neck were not involved. The child was taken for surgery after stabilization, abiding by COVID protocols. The rebar was removed under ketamine sedation with repair of the injury in the floor of her mouth. The postoperative period was uneventful and the child was discharged on the fifth postoperative day. Managing this pediatric trauma emergency was challenging in terms of imaging, securing an airway, and assuring parents about the choices for intervention during lockdown.
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Physiotherapy for simple mastectomy following phyllodes tumor: A case report p. 135
Zoha Badiuzzama Alvi, Manish Prannath Shukla, Abhishek Satyadeo Mishra
Phyllodes tumors are relatively rare breast tumors. Management of these tumors with surgical resection may cause postoperative complications. The purpose of this case study was to define the role of early postoperative physiotherapy in a patient with phyllodes tumor of the breast following simple mastectomy. A 50-year-old woman was brought to the outpatient department following a 1-year history of the lump in the right breast, worsening gradually in the preceding 2 months, and subsequently diagnosed to be a phyllodes tumor. She was treated with simple mastectomy followed by a drain insertion. Postoperatively, she presented with reduced chest expansion and functional mobility and postural impairments. Treatment protocol was set and follow-up was made on the 8th postoperative day. We conclude that early physiotherapy intervention can help in improving the functional mobility and preventing further postoperative complications.
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“Pseudo-polka dot” and “pseudo-corduroy” signs in osteoporotic spine p. 138
Sudhir Saxena, Sonal Saran, Swarnava Tarafdar, Tripti Prajapati
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