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Assessment of patient's knowledge, attitude, and practice regarding pulmonary tuberculosis in a tertiary care hospital
Viplav Narayan Deogaonkar, Saatchi Kuwelker, Smrati Bajpai
January-March 2019, 10(1):18-21
Background: Tuberculosis (TB) is one of the most common respiratory illnesses in India, to the extent that about 1/4th of the population afflicted by TB in the world, is found in India. The knowledge of the patient about the disease, his attitude toward it, and compliance to treatment are key factors in management of the disease. Objectives: The objective of this study is to assess the knowledge, attitude, and practices of the patients with regard to pulmonary TB. Methodology: A cross-sectional observational study was conducted among patients suspected of or diagnosed with pulmonary TB in a Tertiary Care hospital using a prestructured questionnaire. Results: A total of 100 patients participated in the study. Out of these, 74% had never suffered from TB in the past. Cough was identified as a symptom of TB by 75% participants. About 15% participants said they used no precautions while coughing. Conclusion: The study reveals that there are quite a few misconceptions regarding causes, transmission, and prevention of TB. There is still a long way to go to educate the population regarding such a common illness.
  998 156 -
Burden of antenatal depression and its risk factors in Indian settings: A systematic review
Priyanka Arora, Bani Tamber Aeri
April-June 2019, 10(2):55-60
According to the National Mental Health Survey-2016, one in every ten persons in India suffers from depression and anxiety, and 20% of these depressed Indians are pregnant women and new mothers. This systematic review was conducted to assess the burden of depression and risk factors associated with it among the Indian pregnant women. Electronic database (PubMed and Google Scholar) was used to identify any retrospective/prospective observational research studies published in English language which specifically examined antenatal depression (AD) among Indian women using a validated scale. A total of 995 citations were retrieved, out of which only eight studies were included. The prevalence of AD was found to be ranging from 9.18% to 65.0% in northern, western, and southern part of India. However, there is a lack of research on AD from the eastern part of country. The factors such as unplanned pregnancy, multigravidity, history of abortion, advancing pregnancy and age, lower/lower-middle socioeconomic status, poor education status of women, unemployment, bad relations with in-laws, male gender preference, and demand for dowry were significant predictors for AD. Therefore, it is necessary to provide the health-care professionals and women with the knowledge about these factors for early prediction of women at high risk of AD, which might help them to get timely intervention and reduce the burden of depression. Furthermore, the results from this review implicate that more research is needed in future in this field to further validate the findings of the present review.
  1,015 118 -
Hepatitis B virus transmission and health-care workers: Prevention, management, and awareness toward the disease
Bineeta Kashyap, Urvashi Tiwari, Anupam Prakash
January-March 2019, 10(1):6-11
The risk of transmission of hepatitis B, a global communicable disease, has become a matter of concern in recent years. Health-care delivery has the potential to transmit hepatitis B virus (HBV) and hepatitis C virus to both health-care workers (HCWs) and patients. The risk of transmission is most clearly related to the frequency of exposure or the extent of direct contact with human blood and body fluids. Health care must be provided with the best practice of safety and standards of care. Adherence to recommended improved safety devices, standard precautions, and fundamental infection-control practices is a must to prevent transmission of blood-borne pathogens. Long-term treatment with the goal of clearance of HBV is often required. Safe and effective hepatitis B vaccines along with postexposure prophylaxis with hepatitis B vaccination alone or in combination with HBV immunoglobulin have been available, the impact of which has been reported in several countries in preventing HBV transmission among HCWs.
  845 193 -
Listen, care, and going extra mile: Guiding principles for physicians and teachers in health-care profession
Vijay Rajput
January-March 2019, 10(1):1-5
In the medical field, emphasis has been on the development of trust between the physician and the patient, similar to that of a teacher and learner. This is because a solid foundation of trust benefits patients' overall care and students' learning. Trust is critical because it allows the patient to believe that the doctor is there to give them the best care possible. Trust improves the physician–patient relationship because the patient believes he or she is receiving high-quality care as a result. It is important for residents and physicians to be aware of their behavior in their interactions with patients and learners, even if the interaction is only for a few minutes. This awareness is key for the development of trust and long-lasting benefits for clinical care and medical education. Physicians and teachers should develop three crucial skills to develop trust early with their patients and learners: (1) listening, (2) caring, and (3) going the extra mile for patients and learners. These attributes, when applied to patient care and teaching, will travel far in a physician's career and be beneficial to their patients' overall health. This article will explore these three skills and examples of their applications, which medical professionals can use in their day-to-day practice in light of a time-restricting, multitasking, and technologically advanced world.
  933 93 -
Japanese encephalitis: Strategies for prevention and control in India
Ruchir Rustagi, Saurav Basu, Suneela Garg
January-March 2019, 10(1):12-17
Japanese Encephalitis (JE) is an important re-emerging vector-borne zoonotic disease of the 21st century which is the most important cause of morbidity and mortality due to pediatric viral encephalitis in Asian populations. India and China together report 95% of the disease burden where it is also an important cause of acute encephalitis syndrome. JE is a neglected tropical disease which disproportionately afflicts poor and economically disadvantaged populations in rural regions of low and middle-income countries which often lack well-equipped tertiary care centers for the management of JE cases presenting with central nervous system manifestations and related complications. JE has large animal reservoirs among pigs and water birds which renders JE elimination difficult. Hence, current strategy for JE prevention and control pursues a combined approach inclusive of expansion of JE vaccination coverage in endemic regions, vector control, and surveillance. Unfortunately, the lack of public health infrastructure, economic resources, and lack of political commitment has resulted in most endemic countries in the developing world failing to take adequate steps for achieving these recommended measures for JE control, especially with regard to developing surveillance capacities and reference laboratories for the diagnosis of JE. Moreover, the threat of JE has increased in recent years due to factors such as climate change and lack of economic development in several endemic zones even as the disease has begun affecting adult populations. Evidence from surveillance data in some countries also suggests that increase in vaccination coverage for JE does not necessarily correlate with decline in JE disease burden. Ultimately, JE is likely to persist as a major public health problem in the developing world and impede their economic development unless it receives adequate attention from the global health community.
  773 121 -
The knowledge, attitude, and practices relating to tuberculosis among drug-resistant tuberculosis patients
Kevisetuo Anthony Dzeyie, Saurav Basu, Tanzin Dikid
April-June 2019, 10(2):76-78
Introduction: A tuberculosis patient infects several healthy people prior to the diagnosis and initiation of treatment. Indiscriminate spitting in the community has been identified as a challenge to the prevention of tuberculosis; however, knowledge is still limited in terms of actual practices. Methodology: We conducted a descriptive cross-sectional study at a tertiary care hospital to evaluate knowledge, attitude, and practices relating to tuberculosis by interviewing patients of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis using a semi-structured questionnaire. We evaluated knowledge of tuberculosis on etiology, mode of spread, treatment factors, attitudes on the importance the respondent attributed to the factor and practices on adherence to treatment, and hygiene for the prevention of spread including safe sputum disposal. Results: We enrolled 250 patients (165 males) with a mean age of 29 ± 11 (mean ± standard deviation) years. On knowledge of tuberculosis, most of the patients had correct knowledge regarding tuberculosis symptoms (241, 96%), mode of spread (235, 94%), and correct duration of treatments 246 (98%) for drug sensitive tuberculosis. On attitude, all the patients consider adherence to their prescribed anti-tubercular treatment, 246 (98%) on covering mouth while coughing or sneezing and 239 (96%) on safe disposal of sputum as important. However, only 45 (18%) reported practicing correct sputum disposal and 66 (26%) patients reported disposing of their sputum in the open. Conclusion: This study suggests that despite good knowledge and attitude, there is a lack in practice of safe disposal of sputum by tuberculosis patients. Efforts toward sensitization regarding safe disposal of sputum need to be strengthened.
  783 65 -
Non-convulsive status epilepticus presenting as acute confusional state in a young adult
BD Sharma, Amit Kumar Batra
January-March 2019, 10(1):35-38
Nonconvulsive status epilepticus (NCSE) can occur in a variety of clinical conditions and is characterized by prolonged electrographic seizures without clinically discernible seizure activity. It may be one of the most frequently missed diagnoses in patients with altered neurologic function because it is often seen in patients with other serious illnesses. For accurate diagnosis of NCSE, an alteration in baseline cognition or behavior and a concurrent epileptiform seizure pattern on electroencephalography (EEG) must be present. This case of a young adult male presented to our emergency room with an acute onset of confusional state and behavioral changes with no clue for its etiology on initial clinical or after routine investigations including CT brain until EEG picked up continuous epileptic discharges. He responded dramatically to antiepileptic drugs without any recurrence during follow-up of 4 months. Many cases like this are being diagnosed with the use of continuous EEG monitoring (cEEG) in Neurological Intensive Care Units. The advent of cEEG is instrumental in the diagnosis as well as monitoring the response to treatment of this condition with antiepileptic drugs. Increased awareness and a high index of suspicion are needed for timely diagnosis of NCSE if a patient presents with acute onset of unexplainable cognitive or behavioral change of at least 30–60 min duration. Patients with NCSE need to be managed exactly as convulsive SE, using EEG as a guide rather than clinical observations as the determinant of response to treatment.
  701 57 -
Therapeutic benefits of lenalidomide in hematological malignancies
Mohammed Shafi Abdulsalam, Durai Mavalavan Vasudevan Manimoliyan
April-June 2019, 10(2):61-65
Lenalidomide is an immunomodulatory agent, which has action against most of the hematological malignancies. Apart from its immunomodulation, it has other properties such as antiproliferation and antiangiogenesis. It is not only effective in myelodysplastic syndromes and myeloma, recent studies show its effective action on newly diagnosed and relapsed/refractory lymphomas as well. Addition of lenalidomide to standard therapy is associated with lesser central nervous system relapse in diffuse large B-cell lymphomas. Lenalidomide shows promising results in Hodgkin's lymphomas and leukemias (acute myeloid leukemia and chronic lymphocytic leukemia). Dose escalation may be an option in nonresponders with caution in side effects.
  691 66 -
Sources and toxicological effects of lead on human health
Bikash Debnath, Waikhom Somraj Singh, Kuntal Manna
April-June 2019, 10(2):66-71
Lead toxicity is one of the most hazardous metal toxicities. It can enter the body through lead-based paint, dust, water, soil, tableware, and folk medicines. Children are especially prone to develop lead toxicity. Lead acts by inducing oxidative stress due to inefficient replenishment of glutathione. Lead can also cause hemolytic anemia due to disruption of the cellular membrane by lipid peroxidation. Lead toxicity also affects neurotransmitter levels and causes severe health issues related to organ damage, some even leading to death. The main aim of this review article is to summarize lead toxicity detection, its sources, and its mechanism including various toxicological effects on human health. It also focuses on the prevention and treatment of lead toxicity.
  671 71 -
Cardiac manifestations in dengue
Parag Viren Papalkar, Rajesh R Sarode, Sourya Acharya, Sunil Kumar
January-March 2019, 10(1):30-34
Aim: To study the prevalence of cardiac manifestations in patients of dengue fever. Settings and Design: This cross-sectional study was done in a tertiary care hospital conducted for a period of 2 years from September 2016 to October 2018. Methods: Patients with complaints of fever and suspected to have dengue were subjected to dengue serology. Confirmed cases of dengue were then classified according to the World Health Organization criteria into dengue fever, dengue hemorrhagic fever (DHF), and dengue shock syndrome. The assessment of cardiac manifestations was done based on electrocardiogram (ECG), echocardiogram, and cardiac marker. The data was analyzed using statistical significance tests. Results: Out of 60 patients, 36 (60%) were male and 24 (40%) were female, and the male-to-female ratio was 1.5:1. The mean age of the patients was 38 ± 16.69 years. Patients of dengue fever, DHF, and dengue shock syndrome were 51, 7, and 2 respectively. The most common ECG abnormality was sinus bradycardia seen in 9 (15%) patients, followed by sinus tachycardia in 6 (10%) and ST-T changes in 5 (8.33%). Echocardiography was normal in 54 (90%) patients, systolic dysfunction was found in 4 (6.67%) patients, and pericardial effusion was found in 2 (3.33%) patients. Eight (13.33%) patients had abnormal creatine kinase-muscle/brain values. Conclusion: Cardiac manifestations are common in dengue fever, seen in one-third of the patients. Platelet counts < 100,000/mm3 and a higher hematocrit are more likely to be associated with cardiac manifestations.
  592 87 -
Public forum by undergraduate medical students during clinical postings: A way to improve the communication skill
Sumedha Sharma, Aruna Nigam
January-March 2019, 10(1):22-25
Introduction: Excellent communication skills are essential to the practice of medicine as good doctor–patient communication is necessary to elicit information from the patient to arrive at an accurate diagnosis. Aim: The aim of this study was to assess the improvement in the communication skills of undergraduate medical students using public forum as a tool. Methodology: A total of 80 students of 5th-semester MBBS were invited to participate in public forum on the topic of “contraception.” Their communication skills were assessed using the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) assessment of communication skills tool. Each student performed four public forums over 2 months, one every fortnight. Each student delivered 15 min talk once in 2 weeks in front of a group of patients regarding the different contraceptive methods. The assessment of communication skill was done twice, i.e., they were assessed at the first and after the fourth public forum. Paired t-test was applied to assess the improvement in communication skill. Results: The mean score on RANZCOG assessment at the first public forum was 11.92 ± 3.89 and after the fourth public forum was 19.75 ± 6.13 (P < 0.00). An overall improvement in scores was 22.3%. There was a statistically significant improvement in the scores for all the points on the RANZCOG checklist. All the students felt more confident after the public forums. Conclusion: Involving students in small public forums (or patient education programs) helps in improving communication skills and can, in turn, be of great help improving the personality of the future medical professionals as well as in the development of better health-care providers.
  581 64 -
Correlation between serum lipid fractions and radiological severity in patients with drug-resistant pulmonary tuberculosis: A cross-sectional pilot study
Alam Nawaz, Manel Arjun Nayak, Subhangi Thakur Hameer, Ashwin Kamath, Ajit Mahale
April-June 2019, 10(2):99-104
Background: We aimed to determine if serum cholesterol and body mass index (BMI), which are important in maintaining immunity, have any impact on the radiological severity in patients with drug-resistant pulmonary tuberculosis (DR-TB). Materials and Methods: A cross-sectional pilot study was conducted over 2 years in adults with newly diagnosed DR-TB. The radiological severity of the disease was determined using a chest X-ray (CXR) scoring formula. Correlation between the lipid fraction levels, BMI, and the CXR scores was determined using Pearson's correlation coefficient. Results: Thirty-three patients were included in the study. A significant negative correlation was seen between the CXR severity scores and total cholesterol (r = −0.546,P = 0.001), high-density lipoprotein-cholesterol (r = −0.479,P = 0.005), low-density lipoprotein-cholesterol (r = −0.431,P = 0.012), and BMI (r = −0.352,P = 0.044). Conclusions: Low serum cholesterol levels and low BMI were associated with an increased radiological severity which, in turn, could result in increased infectivity. Adequate nutritional supplementation in the diet of patients to increase BMI, and serum cholesterol levels, could potentially decrease the severity, and also consequently, transmission, and incidence of DR-TB.
  596 30 -
Correlation between nephropathy and ophthalmic complications in cases of sickle cell anemia: An entangled association
Aditi Pareek, Aditya Khandekar, Sourya Acharya, Pravin Tidake, Samarth Shukla
April-June 2019, 10(2):72-75
Background: Sickle cell disease commonly presents with unpredictable episodes of vasocclusion and pre mature RBC destruction, which manifest as acute pain and tissue ischemia. In kidneys, endothelial dysfunction occurs in the nephron leading to microalbuminuria, vaso-occlusion, ischemia, infarction, and ultimately nephron loss. Proliferative and non-proliferative retinal changes can also occur, due to similar underlying pathophysiology of vasospasm. Aims and Objectives: To study the correlation between Sickle Cell Nephropathy and Ophthalmic Complications in cases of Sickle Cell disease. Materials and Methods: Thirty five adults aged 18 to 60 years, having Sickle Cell disease were selected as study participants. Complete blood analysis was carried out, with assessment of Urine Albumin: Creatinine ratio and ophthalmic findings, studied by direct and indirect ophthalmoscopy, and slit-lamp biomicroscopy. Results: Patients were divided into two categories: Category I comprising of 7 patients who were admitted to the Medicine ICU with Crisis, and Category II comprising of 28 clinically stable patients. 5 patients from Category I (71.4%), and 2 patients from Category II (7.1%), were found to have findings of peripheral retinopathy. Category I patients had received a mean of 6.17 ± 2.14 blood transfusions, Category II patients had received 2.89 ± 1.81 transfusions, difference being statistically significant. Mean Hb in Category I patients was 6.37 ± 0.35 gm/dl, compared to 7.95 ± 0.81 gm/dl in Category II patients. The mean Urine Albumin/ Creatinine ratio of patients having Ophthalmic manifestations was found to be 286.71 ± 74.75 mg/g, while the mean Urine Albumin/ Creatinine ratio of patients with no Ophthalmic manifestations was found to be 31.82 ± 4.48 mg/g, difference being statistically significant. Conclusion: Sickle Cell nephropathy and retinopathy appear to stem as manifestations of a common underlying mechanism of sickle vasculopathy, and thus can be studied as markers for each other.
  566 56 -
Myocarditis with sinus exit block: A rare presentation of Plasmodium vivax malaria
Aanchal Arora, Manasa Mudalagiri, Deepali Sharma, Yogesh Chandra Porwal
January-March 2019, 10(1):39-41
Although malaria is caused most commonly by falciparum species, vivax malaria counts the second most common in India. Until recently, severe malaria infection was attributed to falciparum species. Various systemic complications including arrhythmia, heart failure, conduction disturbances, and myocarditis have been typically seen in association with Plasmodium falciparum infections. Nowadays, severe vivax malaria encompasses varied complications including cardiac complication as well. We report a case of sinus exit block due to myocarditis in a 40-year-old male infected with vivax malaria without any cardiovascular risk factors. Recovery was complete with a favorable outcome in this case.
  535 54 -
Gastric ascariasis mimicking rapunzel syndrome in an epileptic patient: Learning points galore
Paras Passi, Sumita Kanwar, Swati Chaurasiya, Sumit Vats, Ravinder Kumar, Shalini Singh
January-March 2019, 10(1):42-44
Rapunzel syndrome refers to a very rare condition in which swallowed hair forms a gastric trichobezoar that has a long tail extending into the small bowel. It presents with early satiety, malnutrition, obstructive symptoms, and sometimes, gastric-outlet obstruction. Despite the varied manifestations of Ascaris infestation in man, gastric ascariasis is rare which is demonstrated in the stomach by radiology and by endoscopic examination. We present a rare case of trichobezoar in a 14 years epileptic female with recurrent seizure episodes and no prior history of psychiatric illness or worm infestation where the final diagnosis of gastric ascariasis was made on upper gastrointestinal-endoscopy revealing the presence of worms at the level of the fundus and body of the stomach. Endoscopically some worms were removed, and the rest passed down dead in stools after antihelminthic treatment. Recovery was uneventful and free of complications. Frequent seizures could also be attributed to malabsorption of anti-epileptic drugs because of gastric ascariasis. A prompt diagnosis (tissue diagnosis and direct visualization) always scores above characteristic radiologic findings and appropriate therapy can reduce comorbidities.
  478 64 -
Prevalence of intestinal parasites and risk factors with emphasis on Enterobius vermicularis in children of daycares and preparatory schools of the city of Khodabandeh, Northwestern Iran
Khadejeh Salahi, Amir Javadi, Mehrzad Saraei
April-June 2019, 10(2):89-94
Introduction: Intestinal parasitic infections (IPIs) are considered as a common cause of morbidity and mortality in children in the developing countries. The present study was aimed at examining the status of IPIs in the children of daycares and preparatory schools in the city of Khodabandeh located at Northwestern Iran. Materials and Methods: A total of 520 daycare and preprimary school-age children in the northwest of Iran were tested for the presence of intestinal parasites using direct smear and the standard formalin-ethyl acetate sedimentation techniques. Furthermore, the specific “scotch tape” test was used to identify the eggs of pinworm Enterobius vermicularis. Results: Of total 520 children, 55 cases (10.6%) were infected to intestinal parasites, including 9.2% monoparasitism and 1.4% double-parasitism. The prevalence rate for protozoan infections was 7.3% and 3.65% for helminths. Giardia lamblia infection was shown to have the highest prevalence rate among intestinal protozoa by 3.26%. The prevalence rate for E. vermicularis was 3.5% using “scotch tape” test and stool examination. There was a significant correlation between infection with intestinal parasites and daycares (P = 0.004). A significant inverse correlation was established between anal itching (as a sign of E. vermicularis infections) and hand-washing in children using soap or hand-washing liquid (P = 0.004). Conclusions: Infection with intestinal parasites in children of nursery schools and preschools of the study region, compared to the previous situation, is considerably decreased.
  490 44 -
The cognitive profile and executive function of progressive supranuclear palsy and multiple system atrophy patients
Divya Goel, Arvind Vyas
April-June 2019, 10(2):84-88
Introduction: Multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) are two relatively common forms of atypical parkinsonism seen in movement disorder clinics. This study provides an insight into the cognitive dysfunction in these two diseases. Aims: This study aims at assessing the cognitive and executive dysfunction and investigating the relationship between age, education, Montreal cognitive assessment (MOCA), and frontal assessment battery (FAB) score in a group of Indian patients with MSA and PSP. Materials and Methods: This is a hospital-based observational study with the recruitment of patients of MSA and PSP based on consensus criteria and The National Institute of Neurological Disorders and Stroke and Society for Progressive Supranuclear Palsy criteria, respectively. A total of 50 patients of MSA and PSP admitted or attending outpatient department in the Department of Neurology, SMS hospital, Jaipur, were analyzed for cognitive and executive functions between December 2016 and December 2018 using MOCA and FAB. The Student's t-test was used. The level of significance was determined as itsP value withP < 0.05 taken as statistically significant. Results: On MOCA, impairment was observed in 24% of cases of MSA and 92% of cases of PSP. On FAB, impairment was observed in 20% of cases of MSA and 72% of cases of PSP. Conclusions: Cognitive dysfunction is a major finding in PSP and MSA patients. Thus, cognitive dysfunction in a patient does not rule out MSA as considered in the previous literature and is an important diagnostic finding in PSP; yet requires future research on a larger scale.
  484 38 -
Assessment of economic Burden and quality of life in stable coronary artery disease patients
Lalit Kumar, Anupam Prakash, SK Gupta
January-March 2019, 10(1):26-29
Background: Coronary artery disease (CAD) is known to adversely impact the quality of life (QOL) of the patients and poses an economic burden to the family and society. However, the same has not been estimated in India. Objectives: To estimate the annual economic burden (direct and indirect cost) and QOL in stable CAD patients at a Government Tertiary Care Hospital of Delhi, India. Materials and Methods: A cross-sectional study was carried out in a Government Tertiary Care Hospital of Delhi using a convenient sample of 113 CAD patients. A prestructured pretested questionnaire was used to collect information on direct and indirect costs of therapy for CAD patients, and QOL assessment was done using SF-36 questionnaire. Results: The total average annual cost incurred by patients of stable CAD was Indian National Rupees 15691.45, of which 78.49% was attributable to direct cost (drugs, supplements, diagnostic tests, and transportation charges) while 21.5% to the indirect costs (wage loss of the patient and caretaker, during the days of hospitalization). Both the components of QOL, namely, physical component score (PCS) and mental component score (MCS) were reduced in the stable CAD patients. PCS was 35.53 and MCS was 39.16. Conclusion: CAD poses not only an economic burden on the patient, family, and the society but is also associated with impairment of QOL of the patient too.
  447 57 -
Association of demographic and lifestyle factors with semen quality of men with fertility problems attending infertility center in North Karnataka
Makhadumsab M Toragall, Sanat K Satapathy, Girish G Kadadevaru, Murigendra B Hiremath
April-June 2019, 10(2):79-83
Background: Male factor is responsible for 50% of infertility cases. Universal deterioration in human sperm quality occurring in recent times is receiving a greater attention. The impact of numerous lifestyle factors including age, smoking, alcohol consumption, and exposure to occupational and environmental pollutants is unfavorable to male reproductive health. The present study intended to find out the association of demographic, occupational, and several lifestyle factors on semen quality of men diagnosed with infertility. Materials and Methods: The study enlisted 432 men diagnosed with fertility issue. Couples were administrated with a structured questionnaire to provide their demographic attributes and medical and reproductive health information. The collected data were statistically analyzed using SPSS software version 20.0. Results: The mean age of men was 34.44 ± 0.21 years at the time of consultation. Among seven semen abnormalities, asthenozoospermia was recorded the highest (30.09%). Most of the participants were having secondary education (32.26%), working as laborers (26.62%), and were having multiple addictions (27.77%). Decreased sperm count and motility was noticed among advanced age group and those with addictions. Different occupational statuses had substantial correlation with the sperm quality of participants. Conclusion: The incidence of male infertility and the potent lifestyle aspects studied have displayed an association with each other. However, influence of these aspects on impairment of male fertility can be overcome with modification toward healthier lifestyle.
  467 35 -
Insulin resistance as a predictor of sensory neuropathy in prediabetes
Amrinder Singh, Ajay Chauhan, Parul Goyal, Jasmeet Kaur, Priyamvadha Ramesh
April-June 2019, 10(2):95-98
Objective: The aim of this study is to assess the association of insulin resistance with sensory neuropathy in prediabetes. Materials and Methods: Fasting serum insulin levels were measured and the homeostatic model assessment of insulin resistance (HOMA-IR) was calculated in all patients. These were compared in prediabetic patients having sensory neuropathy to those who did not have sensory neuropathy as determined by vibration perception thresholds (VPTs) measured using Digital Biothesiometer. Furthermore, direct correlation between insulin resistance and VPTs was checked. Results: A total of 60 prediabetic cases were included in this study. Among the study population, the age distribution ranged from 35 years to 60 years with the mean age of 48.68 years. Male and female formed 65% and 35% of the study population, respectively. The maximum fasting serum insulin levels were 21.8 mIU/L, and the minimum fasting serum insulin levels were 3.5 mIU/L, with the mean value being 10.61 ± 4.99 mIU/L. The maximum HOMA-IR was 6.4, and the minimum was 0.986, with the mean value being 2.81 ± 1.37. Among all the prediabetic patients, 43.3% of patients had neuropathy according to VPTs measured using Biothesiometer. T-test analysis suggests that mean fasting serum insulin levels (P = 0.026) and HOMA-IR (P = 0.032) were significantly higher in patients with neuropathy than patients without neuropathy. VPTs were found to have statistically significant positive correlation with fasting serum insulin levels (Pearson correlation coefficient = 0.317 [R], 0.296 [L];P = 0.013 [R], 0.022 [L]) and HOMA-IR (Pearson correlation coefficient = 0.299 [R], 0.281 [L];P = 0.02 [R], 0.03 [L]). Conclusion: Insulin resistance, quantified with the help of the index, HOMA-IR, has an important role in the development of this sensory neuropathy.
  429 37 -
Anemia in pregnancy: Think beyond iron deficiency
Faisal A Memon, Vikram A Londhey, Raju J Nagara
April-June 2019, 10(2):111-113
We hereby describe a rare case of delta beta (δβ)-thalassemia as a cause of anemia in a 2-month pregnant female who was diagnosed as homozygous δβ-thalassemia after gene mutation studies. δβ-thalassemia is an unusual variant of thalassemia with elevated level of fetal hemoglobin. Homozygous patients of this disorder, unlike β-thalassemia, show mild anemia and give a clinical picture similar to that of thalassemia intermedia. However, δβ-thalassemia heterozygotes clinically show the characteristics of thalassemia minor.
  414 48 -
Presternal bronchogenic cyst: A rare presentation
Suhas Jajoo, Samarth Shukla, Sourya Acharya
April-June 2019, 10(2):105-107
Among the various congenital anomalies of the respiratory system, the extrapulmonary bronchogenic cyst is a rare pathologic lesion. The bronchogenic cyst is a developmental anomaly, occurring due to malformation of ventral foregut during the first 6 weeks of the intrauterine life. The cystic abnormality presents in infancy, children, and often in young adults. A case of 27-year-old male presented with subcutaneous swelling in the presternal area. The nodular swelling was excised and subsequently sent for surgical pathology examination. The cystic swelling was diagnosed on histopathology as a cutaneous bronchogenic cyst.
  413 36 -
Worm causing diabetes
Akanksha Singh, Ajay Chauhan, Amrinder Singh, Parul Goyal, Piyush Jain
April-June 2019, 10(2):108-110
Hydatid disease or echinococcosis is one of the oldest known zoonotic diseases. Although known to be found in liver and lungs, these cysts are rarely found in the pancreas. We report a patient who not only had hydatid cyst in the pancreas but also pancreatitis and subsequently diabetes because of it.
  387 46 -
Exploring the data required for evaluation of a competency-based medical education curriculum in India
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
April-June 2019, 10(2):114-115
  366 23 -
A case of flaccid quadriparesis
Kashish Gupta, Subhash Kumar, Narendra Bishnoi, Mayank Gupta, Sunil Kumar Mahavar, Raman Sharma
January-March 2019, 10(1):45-47
Inclusion body myositis (IBM) is the most common inflammatory myopathy above the age of 50 years and three times more common in males than females. It presents as a distal more than proximal myopathy and has an indolent progressive course. Despite the latest advancements, it is challenging to diagnose this disease as it may resemble amyotrophic lateral sclerosis (ALS) clinically and polymyositis histopathologically. What sets it apart from the other myopathies is the fact that it has a very poor response to standard therapies of steroids and immunosuppressants. We present a case of a 30-year-old female patient presenting with relatively rapid onset of quadriparesis and dysphagia which was ultimately diagnosed with IBM. This case report attempts to highlight the difficulties in diagnosing this rare disease and the limited modalities of treatment.
  345 41 -