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   Table of Contents - Current issue
Coverpage
July-September 2019
Volume 10 | Issue 3
Page Nos. 117-177

Online since Monday, August 19, 2019

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ORIGINAL ARTICLES  

Assessment of the air quality and its impact on health and environment in India p. 117
Mradul Kumar Daga, Govind Mawari, Dipu Bharali, Himanshi Banker, Priya Mehar, Prachi Saluja, Diksha Kumar, Dikshant Kumar, Manish Kumar Jha, Prashant Gargava
DOI:10.4103/INJMS.INJMS_15_19  
Introduction: The health impact of air pollution caused by firecrackers used during festival time is an area of great concern in Indian population. Trapping of pollutants due to burning of firecrackers during Diwali and Dusshera festivals promotes the formation of smog, which leads to raise in respirable suspended particulate matter (RSPM) and SPM values above the standard values. Aim: This study was designed to assess the air quality pre- and post-Diwali and Dusshera in North India and also to find out the exposure effect of poor air quality on the health of population as well as health risk assessment of the population. Materials and Methods: A total of 470 individuals of different age groups were interviewed during Dusshera festival (i.e., both pre- and post-Dusshera) in four chosen areas. Besides, 788 individuals of different age groups were interviewed during Diwali festival (i.e., both pre- and post-Diwali) in the same four areas. A total of 223 individuals also underwent pulmonary function testing (portable spirometry) on a random basis (fifty in each area, 3 days before and after Diwali). Results: The comparison of respiratory disease complaints pre- and post-Diwali showed that there was a significant increase in the complaints of cough post-Diwali among the participants of Kotla (6.7% vs. 28.9%). However, there was a significant decrease in cough and breathlessness post-Diwali in Parivesh Bhawan. The ambient air quality of three residential areas was within normal limits both pre- and post-Diwali with respect to sulfur dioxide and nitrogen dioxide, but there was an increase in the levels of PM10 and PM2.5 post-Diwali. Conclusion: The level of suspended particles in the air increases alarmingly which can be associated with eye, respiratory, and allergic problems. Crackers and fireworks were found to be the chief sources of air pollution during festivals in India. Even though the impact of Diwali is short term, the short-term exposure of these pollutants in the environment affects the standard values of air particulate and can cause health complications.
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Internet: A double-edged sword? – A cross-sectional study p. 126
Meera George, Malik Shanawaz Ahmed, Neethu George, Sony Simon
DOI:10.4103/INJMS.INJMS_26_19  
Introduction: The Internet has become a must-present factor in our day-to-day life. As like any other substance like plastic, the Internet also demonstrates threats which affect health and thereby life also. Objectives: To find the prevalence and impact of internet addiction on health and lifestyle of medical students in a private medical college in Kerala. Methodology: This cross-sectional study was conducted among medical students for a period of 1 month. A questionnaire was used to document the sociodemographic details, internet addiction by young's Internet Addiction Test, and questions regarding impact of the Internet on life. Results: In the present study, we found that 71% of students (mild 107 [54%] and moderate 34 [17%]) had internet addiction. Internet addiction was significantly associated with male gender, mobile/tablet usage, eye strain, time to initiate sleep, frequency of sleep trouble, hours spent on the Internet, money spent, presence of backache, and appetite change with internet addiction. Conclusion: The study finding of presence of internet addiction has to be considered seriously along with tobacco and alcohol consumption. Awareness has to be made relating to the right use, right amount, and right time of using the Internet.
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Comparative analysis of nerve conduction study methods in patients with carpal tunnel syndrome p. 131
Deepak Jain, Pankaj Kumar Saini, Chandra Mohan Sharma, Banshi Lal Kumawat
DOI:10.4103/INJMS.INJMS_34_19  
Background: Patients with mild-to-moderate carpal tunnel syndrome (CTS) may not be picked up by routine nerve conduction methods. Hence, this study was performed to identify the most sensitive way to detect mild-to-moderate CTS and to evaluate the sensitivity of different methods for the diagnosis of CTS. Subjects and Methods: We included 60 clinically confirmed CTS patients in our study. We recorded the clinical characteristics and laboratory features in a prescribed proforma. We also included 60 healthy age- and sex-matched asymptomatic individuals as controls in our study. We excluded patients with underlying peripheral neuropathy. We included median distal motor latency, median distal sensory latency, median-versus-ulnar second lumbrical-interossei comparison study, median-versus-ulnar wrist-to-digit four comparison study, median-versus-radial thumb sensory study, median-versus-ulnar motor distal latency difference, and median-versus-ulnar sensory latency difference tests in our study. Results: Of 60 patients, female: male ratio was 2.3:1, and the mean age was 44.28 ± 11.41 years. Mean symptom duration was 0.76 ± 0.03 years. Of 42 females, 38 (90.4%) were engaged in daily household activities. In patients group, median nerve distal motor latency was 5.024 ± 2.05 ms, whereas sensory latency was 3.53 ± 0.75 ms. Sensitivity was the highest in median-versus-ulnar wrist-to-digit four comparison study (90.19%), followed by median-versus-radial thumb sensory study (88.23%), and median-versus-ulnar second lumbrical-interossei comparison study (86.27%). Median distal motor latency test had the lowest sensitivity (72.55%). Conclusions: In patients with mild CTS, electrophysiological tests including median-versus-ulnar wrist-to-digit four comparison study, median-versus-radial thumb sensory study, and median-versus-ulnar second lumbrical-interossei comparison study should be incorporated to improve the sensitivity for the diagnosis of CTS.
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Assessment of growth and development in toddlers: A mixed method approach for developmental surveillance and screening by a healthy baby contest in an urban resettlement colony of Delhi, India p. 137
Anita Shankar Acharya, Nidhi Tiwari, Archana Thakur, Sanjeev Kumar Rasania, Damodar Bachani, Jyoti Khandekar
DOI:10.4103/INJMS.INJMS_40_19  
Introduction: Under-five mortality is still a major concern in India, and we are very far from reaching Millennium Development Goal 4, i.e., reducing child mortality. Various key interventions have been developed to reduce child mortality which needs to be implemented in an integrated manner by our health-care workers. Sole focus of our physicians at primary health-care centers is either clinical management of the child or immunization. In this study, for the overall assessment of the child, a comprehensive healthy baby scorecard has been designed to objectively assess the overall health status of the child and factors affecting it. Methodology: The study was a pilot study designed as healthy baby show contest at an urban health center (UHC) in a resettlement colony of east Delhi. A total of 36 mother–child pairs (children were in the age group of 0–3 years) were enrolled at the UHC for the comprehensive assessment of the child using healthy baby scorecard. Weightage was given to growth which was assessed by three criteria: weight for age, length/height for age, and weight for length/height. In-depth interviews of mothers were conducted to assess their understanding about child development. Results: Overall, 61.1% (n = 22) of participants showed satisfactory nutritional status. Of 14 children with poor nutritional status, 50% of mothers perceived their child to be healthy. Exclusive breastfeeding was present in only 10% of the participants. Correct knowledge about child's normal development was present in 17%–30% of the mothers for various aspects of child rearing. Conclusion: Healthy baby show conducted revealed that child-rearing practices were not conducive for the child's normal development and growth. The main factors are poor knowledge of mother in the concept of child development and child-rearing practices besides other factors such as social and cultural.
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Substance abuse and depression among auto-rickshaw drivers: A study from the national capital region of Delhi, India p. 143
Shaurya Kaul, Anish Kumar Gupta, Taposh Sarkar, Syed Khursheed Ahsan, Narinder Pal Singh
DOI:10.4103/INJMS.INJMS_64_19  
Introduction: Auto-rickshaw driver is exposed to many kinds of risks owing to his profession, such as stressful occupational conditions, environmental pollution, and drug abuse such as smoking, tobacco, and alcohol use. The present study is an attempt to estimate the prevalence of substance abuse and depression among auto-rickshaw drivers and compare these with nonauto-rickshaw drivers. Subjects and Methods: A total of 120 participants were enrolled randomly in the study, i.e., 60 each from auto-rickshaw drivers and nonauto-rickshaw population. To fulfill the objective, methodology based on the test application of the Beck's Depression Inventory, Hamilton Anxiety Rating Scale, and alcohol, smoking, and substance involvement screening test was used. A predesigned questionnaire was used that included information such as general health status, habits, addictions, and work experience. To establish statistical relationships between two or more random variables, the Pearson correlation coefficient was also calculated. Results: In the present study, significant high prevalence of tobacco and alcohol use was seen among auto drivers, 83.3% and 63.3% as compared to nonauto-rickshaw drivers (tobacco and alcohol, 46.6% and 46.1%, respectively). The prevalence of depression in auto-rickshaw drivers was 90% (mild-to-severe range) which was significantly high compared to nonauto-rickshaw drivers (60%). On the Hamilton Anxiety Rating Scale, more than half of the auto-rickshaw drivers, i.e., 60%, had mild-to-moderate anxiety which was higher than nonauto-rickshaw (5%). Driving experience, age, and substance abuse (alcohol and tobacco use) showed a significant association with depression. Conclusion: This study demonstrated a high prevalence of depression, anxiety, and substance abuse in auto-rickshaw drivers. There was a positive correlation of depression with substance abuse (alcohol and tobacco), age, and work experience. This study will assist the psychologist to understand and treat the mental health issues among professional drivers.
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Association of absolute lymphocyte count and circulating CD4+ and CD8+ t-cells with positive clinical outcome in survivors of cancer: An observational study p. 149
Suresh Rao, Venkatesh Ponemone, Krishna Prasad, Sanath K Hegde, Prajna D'silva, Manjeshwar Shrinath Baliga
DOI:10.4103/INJMS.INJMS_20_19  
Background: The objective of this observational study is to determine the changes in the circulating immune cells as a predictor of outcomes in patients who have survived cancer. Materials and Methods: A peripheral blood immune-profile evaluation was performed in all the survivors of cancer (n = 66) during their visit to the hospital for regular follow-up and thereafter followed up for two consecutive years for any morbidity or mortality. The changes in hematological and biochemical parameters were evaluated in all the patients. The frequency of circulating lymphocyte cell population i.e., CD3+, CD4+, and CD8+ lymphocytes were analyzed using flow cytometry in the peripheral blood of the patients. The variability in the circulating lymphocytes was correlated with tumor relapse and overall survival (OS). Results: In the study, 47 of the 66 patients with cancer survived at the end of 2 years observation time period, while 19 patients died due to infection related complications and not due to tumor relapse. A significant reduction in the neutrophil (P < 0.0001) and lymphocyte (P < 0.0001) counts were observed in patients who succumbed to the illness within 2 years when compared to the cohorts that were surviving. A statistically significant reduction in the absolute lymphocyte counts (P < 0.004), absolute CD3 (P < 0.0001), CD4 (P < 0.002), and CD8 (P < 0.04) were observed in the deceased group compared to the surviving group. CD4/CD8 ratios between both live and deceased groups did not show any significant difference. Conclusion: This preliminary observational study indicates a correlation of circulatory lymphocytes to OS in survivors of cancer and that it could be a predictive marker.
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Knowledge and practices regarding the prevention of tetanus among adults of resettlement colony of Delhi, India p. 155
Neha Dahiya, Rajesh Kumar, Gajendra Singh Meena, Palak Goel
DOI:10.4103/INJMS.INJMS_36_19  
Background: Community awareness about tetanus immunization schedules and its importance in preventing tetanus is very low. Aim: This community-based, cross-sectional study was conducted to assess the knowledge, attitude, and practices about tetanus toxoid (TT) immunization among the general population in a resettlement colony of East Delhi. Materials and Methods: Stratified random sampling was done. There were five blocks and 50 participants were taken from each block randomly. The study was explained to the prospective participants during routine home visits. The study was conducted over a 3-month period from November 2017 to January 2018. Adult residents of the urban resettlement colony, of either sex, who gave written informed consent to participate in the study, were interviewed at their homes, at a time convenient to them, using a semi-structured proforma, and their responses were recorded and analyzed using the SPSS version 20. Results: Of the 250 participants enrolled, 230 persons who were willing to respond were included. The mean age was 35.9 years. 68.3% of the participants were female and 31.7% were male. Awareness of tetanus immunization regarding injury shows that only 52.1% of the respondents knew about the need of tetanus injection after injury beside other measures such as medicine and bandage. This knowledge was significantly associated with education. Majority (85.6%) of the respondents did not know the correct schedule of tetanus prevention immunization schedule in children. Only 30.8% of the participants knew that diphtheria and tetanus toxoid prevents tetanus. Conclusions: Sustained and focused health education efforts are necessary to combat misconceptions regarding TT immunization.
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CASE REPORTS Top

Behcet's disease and ankylosing spondylitis: A rare association p. 159
Amina Mounir, Siham Driouach, Salah El Khader, Ali Zinebi, Mohammed Karim Moudden
DOI:10.4103/INJMS.INJMS_23_19  
The overlap syndrome is frequently encountered in rheumatology, but the coexistence of Behçet's disease and ankylosing spondylitis is considered to be rare. We present a case of this interesting coexistence in a 49-year-old male with positivity for HLA-B51 and negativity for HLA-B27.
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Acute quadriplegia: An interesting case with etiological and pathophysiological disparity p. 162
Vivek Pal Singh, Jai Khullar, Ashutosh Garg, Anil Vardani
DOI:10.4103/INJMS.INJMS_47_19  
Acute quadriplegia is a neurological emergency infrequently encountered in clinical practice. Localization of acute quadriplegia ranges from central nervous system, spinal cord, anterior horn cells, peripheral nerve, neuromuscular junction, and rarely muscles. Important etiologies of acute quadriplegia are cerebrovascular accident, trauma, demyelination, channelopathies, metabolic disturbances, and toxins. An astute physician can easily localize the neurological lesion, however, when there are confounding investigations particularly when the investigations are gold-standard for the etiologies under diagnostic consideration, it becomes difficult to attribute the cause of quadriplegia to a particular disease process. Then, the diagnosis is entirely clinical and depends on the type of clinical response obtained after the treatment of patients. We report a case of acute quadriplegia whose investigations favored both demyelination and metabolic derangement. Good clinical outcome was achieved when one of the etiologies was entertained for treatment for obvious reasons.
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Retrobulbar neuritis: Rare presentation in dengue fever p. 166
Atul Bhasin, RK Singal, Atul Prasad, Rahul Handa, Harsh Mittal
DOI:10.4103/INJMS.INJMS_56_19  
Dengue fever is transmitted by the bite of infected female Aedes aegypti mosquito. There has been a worldwide resurgence of disease over the past few decades. Southeast Asia, American tropics, and subtropical countries have seen many epidemics in recent past, with the annual incidence of disease exceeding 50–100 million per year. Dengue fever is characterized by fever, malaise, headache, muscle ache, retro-orbital pain, purpuric rash, and bleeding diathesis due to thrombocytopenia. Neurological symptoms have been reported as changing clinical profile of dengue infection. Encephalopathy and encephalitis are being increasingly reported other than hemorrhagic cerebrovascular presentations. Ophthalmic complications involving the anterior and posterior chambers have been reported with varying incidence. Blurring of vision, scotoma, retinal hemorrhages, macular edema, and optic neuropathy have also been reported. We report here a rare case of retrobulbar optic neuritis in a case of dengue fever which showed complete recovery from ocular symptoms on recovering from dengue fever.
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Idiopathic pulmonary hemosiderosis: A differential diagnosis of pulmonary tuberculosis in a young child p. 170
Shelley Shamim, Suptish Biswas, Suman Mandal
DOI:10.4103/INJMS.INJMS_44_19  
Idiopathic pulmonary hemosiderosis (IPH) is a rare disease diagnosed primarily in children and young adults, characterized by recurrent diffuse alveolar hemorrhage which leads to the deposition of hemosiderin-laden macrophages in the lung. It is a diagnosis of exclusion and requires a high level of clinical suspicion. It may remain undiagnosed for years, hence often mistreated. Here, we describe such a case of IPH in a 15-year-old male who was initially mistreated twice as clinically diagnosed pulmonary tuberculosis first with Category 1 and then Category 2 antitubercular drugs. He had a history of two episodes of hemoptysis, recurrent episodes of paleness, persisting weakness, and shortness of breath. He also had bilateral reticulonodular opacities on chest skiagram. His history raised the suspicion, the presence of hemosiderin-laden macrophages in bronchoalveolar lavage, and transbronchial lung biopsy strongly suggested the diagnosis. However, the final diagnosis came out after ruling out all the probable causes.
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LETTERS TO THE EDITOR Top

Interaction of rifampicin with antihypertensive medications in chronic kidney disease patients: Clinical implications p. 174
Ramnik K Duggal, Ganesh P Agrawal
DOI:10.4103/INJMS.INJMS_52_19  
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“Wine Glass” sign in a case of juvenile amyotrophic lateral sclerosis p. 176
Arvind Vyas, Divya Goel
DOI:10.4103/INJMS.INJMS_53_19  
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