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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 11 | Issue 1
Page Nos. 1-57

Online since Wednesday, February 12, 2020

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EDITORIAL  

The skills medical students need to succeed in medical school and prevent burnout p. 1
Vijay Rajput, Anuradha Lele Mookerjee
DOI:10.4103/INJMS.INJMS_1_20  
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ORIGINAL ARTICLES Top

Implementation of antimicrobial stewardship activities in India p. 5
Arzoo Sahni, Arti Bahl, Rashi Martolia, Sudhir Kumar Jain, Sujeet Kumar Singh
DOI:10.4103/INJMS.INJMS_118_19  
Introduction: The ease of availability of antimicrobials and their excessive use is a growing issue which has significantly contributed to antimicrobial resistance (AMR). This is a matter of public health concern as the burden of AMR is far outpacing the research and development work done to develop new antimicrobials. India, being one of the top consumers of antimicrobials, now faces this threat which can only be curtailed through the implementation of antimicrobial stewardship program (AMSP). To address this issue, this systematic review attempts to study the implementation activities of AMSP in the country by the means of literature review. Methods: A comprehensive research using web-based search engines was performed employing a combination of search string: AMSP, ASP, implementation, impact, antibiotic stewardship, antimicrobial surveillance, infection control, and resistance control. The search yielded thirty papers between the time period of 2008 and 2019. 17 papers fulfilling the inclusion-exclusion criteria were taken up for review, employing PRISMA framework. Results: Results from different studies conducted on implementation of AMSP and its components were consolidated and analyzed to track the extent of AMSP activities. Moreover, by studying AMSP practices, gaps in implementation activities were identified by highlighting the AMSP components that were not fully utilized in the country. Conclusion: The results show that implementation of AMSP in India is still in its nascent stage as all the stewardship components are yet to be fully applied in the country. There seems to be a lot of scope in improving the implementation activities by building and strengthening of components such as use of information technology in monitoring and surveillance, use of antibiotic cycling and sensitizing staff, and broadening the role of different staff members to develop an effective program in the nation which meets the goals of National Action Plan-AMR.
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Clinical and laboratory profile of people afflicted with melioidosis: A retrospective study p. 10
Ponmaleri Koroth Swapna, Ramakrishna Pai Jakribettu, Thomas George, Ponmaleri Koroth Manoj Kumar, Manjeshwar Srinath Baliga
DOI:10.4103/INJMS.INJMS_45_19  
Aim: Melioidosis, caused by Burkholderia pseudomallei, is an important disease in some parts of the developing countries and is now categorized as an emerging infection and a global threat. The present study was carried out to ascertain the alterations on the hematological, hepatic, and renal parameters in the infected people. Materials and Methods: This was a retrospective study and was conducted in a tertiary care hospital in India. Data were analyzed in people who were diagnosed to be infected by B. pseudomallei during January 2010–December 2016. A total of 28 people were included in the study and compared with healthy individuals who were tested negative for any infectious and chronic diseases. Results: The results indicated that the infection caused diverse clinical manifestations such as fever, cough, dyspnea, joint pain, headache, bodyache, weight loss, swelling, and decrease in appetite. There was significant difference in the various hematological and hepatic endpoints, while there was no such difference in the renal function test parameters. Conclusions: For the first time, this study indicates that acute infection with melioidosis causes alterations in hematological and hepatic parameters in people with melioidosis.
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Effect of exercise training on dimensions of quality of life and fatigue in people with congestive heart failure class II and III: A randomized controlled trial p. 15
Ali Hasanpour-Dehkordi, Mitra Yadollahi, Shahriar Salehi Tali, Reza Ghanei Gheshlagh
DOI:10.4103/INJMS.INJMS_43_19  
Background: Improved living conditions and increased life expectancy have led to aging in societies. Increased incidence of chronic heart disease is one of the most important economic, social, and health challenges of the 21st century. Aim: This study aimed to examine the effect of exercise training on dimensions of quality of life and mental status in people with congestive heart failure Class II and III. Materials and Methods: This study was carried out on patients with chronic heart failure. For this purpose, 52 eligible patients were chosen and randomly divided into case and control groups. The participants in the case group were asked to follow an exercise program three sessions per week in the morning for 24 weeks. This exercise program comprised 5–10 min of warming, 20–30 min of exercise, and 5 min of cool-down. Data were collected by the SF-36 questionnaire and analyzed by the SPSS version 18. Results: The results revealed that there was a significant difference in the mean score of various dimensions of quality of life including NYHA functional Classes II (P = 0.032) and III (P = 0.027), fatigue, BP, and general health in Classes II (P < 0.001) and III (P = 0.021) between the two groups before and after the intervention. Conclusion: Given that exercise leads to improvement of physical functioning, role-physical, role-emotional, social functioning, mental status, general health, and lower levels of fatigue and body pain in patients with congestive heart failure, it is recommended that patients incorporate regular exercise into their daily routines.
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Prevalence of pathological lesions in 161 nephrectomies: An experience from a teaching hospital in urban industrial area of Maharashtra p. 21
Shirish S Chandanwale, Piyusha Naragude, Madhuri Singh, Akshi Raj, Sunita Bamanikar, Archana C Buch, Kushal Shah
DOI:10.4103/INJMS.INJMS_127_19  
Background: Kidneys can be involved in various pathological processes. Nephrectomy is a common procedure in urological practice. Aim: The objective of the present study is to find out the frequency of various neoplastic and non-neoplastic lesions in nephrectomy specimens and to study histomorphological features from a teaching hospital in urban industrial area. Materials and Methods: The study included 161 nephrectomy specimens. Grossly, findings were noted. Detailed histological features were studied. Lesions were broadly categorized into non-neoplastic and neoplastic. Nuclear Grading System was used to grade clear-cell renal cell carcinoma (RCC) and papillary RCC. The International Society of Pediatric Oncology staging was used to stage Wilms', tumors. The staging of RCC was done by tumor, node, and metastasis classification as per the World Health Organization 2016. Other clinical details were correlated with histomorphological features. Results: Of 161 nephrectomy specimens, 81 (50.31%) were males and 80 (49.68%) were females. The mean age was 45.43 (±19.43 standard deviation) years. 115 (71.42%) nephrectomy specimens showed -non-neoplastic lesions and 46 (28.57%) showed neoplastic lesions. The most common non-neoplastic lesions were chronic pyelonephritis in 106 (92.17%) patients. RCC (n = 36) was the most common neoplastic lesion. Conclusion: In developing countries like India, chronic pyelonephritis remains the most common cause of nephrectomy. Nephrectomy due to non-neoplastic lesions is more common in younger age group as compared to neoplastic lesions. Early diagnosis and better treatment modalities for inflammatory lesions of the kidney in the developing countries will reduce the rate of nephrectomies.
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Nail fold capillaroscopic changes in patients with type 2 diabetes mellitus: An observational, comparative study p. 28
Deepak Jakhar, Chander Grover, Archana Singal, Gopal Krushna Das, SV Madhu
DOI:10.4103/INJMS.INJMS_146_19  
Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease affecting microvascular circulation causing complications such as retinopathy, nephropathy, and neuropathy. Nail fold capillaroscopy (NFC) is an in vivo study of microvascular circulation. Aim: The aim of this study is to describe and quantify NFC changes in type 2 diabetics. Materials and Methods: NFC was done for all 10 fingernails for 96 patients with T2DM (as per the American Diabetes Association criteria) and 40 healthy controls. The diabetics were further subdivided into two groups: those with microvascular complications (Group 1, n = 46) and those without any (Group 2, n = 50). Results: Demographic profile was comparable in both the groups. Overall, 80.2% (77/96) of the patients with T2DM showed NFC changes as compared to 12.5% of the healthy controls. Unique morphological alterations in T2DM were angulated and receding capillaries. Mean capillary density was overall reduced, especially in Group 1 (6.57 ± 1.02 capillary/mm) as compared to Group 2 (7.03 ± 1.09 capillary/mm) (P = 0.67). Overall, 89.13% of Group 1 patients had NFC changes as compared to 72% in Group 2 (P = 0.035). Specific morphological changes were also significantly more common in Group 1 than Group 2, including tortuosity (P = 0.035), meandering capillaries (P = 0.004), capillary dropouts (P = 0.012), and bizarre capillaries (P = 0.002). Limitations: A larger sample size study with different demographic populations could have provided a broader picture of NFC changes in T2DM. Conclusion: Our study suggests that NFC changes are correlated with microvascular complications in type 2 diabetics, possibly helping in noninvasive identification of patients at risk.
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Effect of hypothyroidism on cognitive status: Evidence from stroop task p. 34
Shilpi Goyal, Abhinav Dixit, Neelam Vaney, SV Madhu
DOI:10.4103/INJMS.INJMS_144_19  
Background: Very less work has been done in the past to assess cognition in hypothyroid patients using classical color-word Stroop task. The Stroop color-word task is a well-recognized tool which estimates cognitive inhibition. Stroop task is based on the fact that reading words and identifying color of written words are two different information and they process with a common response channel but with different speeds. The aim of this study was to assess the cognitive inhibition process in drug-naïve hypothyroid patients and their comparison with the same patients after the attainment of euthyroid status and also with euthyroid controls using classical color-word Stroop task. Materials and Methods: Thirty drug-naïve newly diagnosed hypothyroid patients were study cases who underwent Stroop task once before initiating treatment and then after the attainment of euthyroid state. We performed the same test in euthyroid controls twice at an interval of 3 months for comparison purpose. Correlation analysis was also done for hypothyroidism and cognition. Results: The reaction time of Stroop task was decreased in all the three conditions of each block, i.e., neutral, incongruent, and congruent conditions after the attainment of euthyroid state, and the finding confirms posttreatment modulation of the attention processes in hypothyroid patients. Reaction time of Stroop task in hypothyroid patients was positively correlated with the serum thyroid-stimulating hormone levels. Processing of color identification was suppressed than reading words in hypothyroid patients as evidenced by increased reaction time of Stroop task. This increase in reaction time can be reversed by earlier identification of drug-naïve hypothyroid cases so that they can get timely treatment to restore their cognitive status. Conclusions: Stroop task scores are reduced in overt hypothyroid patients, but improve after thyroid replacement therapy.
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CASE REPORTS Top

Lupus and lymphoma: An intriguing association p. 40
Saurabh Gupta, Rajesh Chetiwal, Poonam Gupta, Priyank Rastogi, Amit Kumar
DOI:10.4103/INJMS.INJMS_132_19  
A 21-year-old female patient, diagnosed with systemic lupus erythematosus (SLE) without renal involvement on remission with oral corticosteroids and hydroxychloroquine for the past 6 months. presented again with a history of polyarthralgia, weight loss, high-grade fever, and neck swelling. Histological and radiological studies confirmed non-Hodgkin's lymphoma subtype diffuse large B-cell type. We thus report an infrequent and intriguing association of non-Hodgkin's disease with SLE. The awareness of the association of non-Hodgkin's disease with SLE and its modes of presentation will help in the early diagnosis and management of such patients.
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Eisenmenger syndrome with pregnancy – Double trouble p. 44
Juvva Kishan Srikanth, Nitesh Gupta, Shibdas Chakrabarti, Pranav Ish
DOI:10.4103/INJMS.INJMS_138_19  
Eisenmenger syndrome is an absolute contraindication for pregnancy. However, those patients with a diagnosis in late 2nd or 3rd trimester need to be carefully evaluated with a multidisciplinary team and strictly monitored by a critical care intensivist. We present a case of Eisenmenger syndrome diagnosed late in pregnancy, managed conservatively in intensive care unit with positive airway pressure therapy.
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LETTERS TO THE EDITOR Top

Core clinical characteristics of neuromyelitis optica spectrum disorder mnemonic p. 47
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
DOI:10.4103/INJMS.INJMS_140_19  
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Artery of percheron stroke: A rare presentation p. 49
Abhishek Juneja, Kuljeet Singh Anand, Brijlal Choudhary
DOI:10.4103/INJMS.INJMS_141_19  
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Hypokalemic paralysis due to primary sjögren syndrome: Literature review p. 51
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
DOI:10.4103/INJMS.INJMS_135_19  
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Employment of AWaRe tool in reducing the emergence of antimicrobial resistance: The World Health Organization p. 54
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/INJMS.INJMS_136_19  
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Cerebral vasculopathy in progressive systemic sclerosis: A rare presentation p. 56
Abhishek Juneja, Rajat Jhamb
DOI:10.4103/INJMS.INJMS_155_19  
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