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   Table of Contents - Current issue
January-March 2023
Volume 14 | Issue 1
Page Nos. 1-66

Online since Tuesday, February 14, 2023

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Umbilical cord blood banking: Myth and realities p. 1
Aruna Nigam
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Diabetes remission: Myth or reality? p. 3
Ashok Kumar, Shubha Laxmi Margekar, Ravi Kumar
The rising prevalence of diabetes mellitus (DM) increases the burden of morbidity and mortality worldwide. DM is recognized as an independent risk factor of cardiovascular mortality. Uncontrolled diabetes leads to various long-term microvascular and macrovascular complications. Optimum control of glycemia is desirable to prevent these complications to improve quality of life and decrease mortality. The concept of remission or reversal of diabetes is evolving for many decades and various definitions and approaches to achieve remission also have evolved. Obesity-related surgeries had shown remarkable control of blood glucose levels. Recently, therapy directed toward weight loss either by medical nutrition therapy, physical activity, or anti-diabetic medications seems promising in achieving remission of diabetes.
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Impact of severe acute respiratory syndrome-coronavirus-2 pandemic on postgraduate medical education in armed forces medical services institutions: A students' perspective p. 9
Nithya Nair, Mansur Ali Khan, Vijoy Kumar Jha, Debasish Mahapatra
Introduction: The Severe acute respiratory syndrome coronavirus 2 pandemic situation brings us the opportunity to test the strength and limitations of our health delivery system. Residents being the backbone of quality-health-delivery of any institute have taken the brunt. Materials and Methods: A cross-sectional self-administered questionnaire-based survey was used to assess the effect on medical training and stress of postgraduate residents in clinical specialties of armed forces institutions. Results: 266 valid responses were analyzed. Eighty-seven percent of residents felt their surgical/procedure-related training was affected. Bedside/clinical training was found to be affected by 92% and theoretical learning by 78%. A significant difference was found between residents in medical and allied specialties and residents in surgery and allied specialties (81% vs. 96.3%) with regard to the negative effect of the COVID-19 pandemic on surgical/procedural skills training (P < 0.05). There was a significant difference in the likelihood of being posted for COVID duties based on gender (P = 0.01) and year of the course (P = 0.004). Posting on COVID duties did not significantly affect surgical, clinical, or theoretical training. Of the respondents, 37%, 49%, and 14% had a mild, moderate, and severe increase in stress, respectively. 18%, 52%, and 30% experienced mild, moderate, and severe increased stress among family members. Gender, age, category, year of residency, or subject of specialization did not have any significant effect on the level of personal or family stress. Conclusion: This survey attempts to bring forth the effect of the pandemic on medical training schedules and stress among residents. Such surveys would enhance understanding and bring solutions to the problem that the pandemic has brought.
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Vaginal birth after cesarean score for the prediction of successful vaginal birth after cesarean section – A prospective observational study p. 15
Neha Varun, Aruna Nigam, Nidhi Gupta, Farhat Mazhari, Varun Kashyap
Aim: The aim of this study was to evaluate the demographic and obstetrical factors affecting the chances of vaginal birth after cesarean (VBAC) delivery and to develop a scoring system for the prediction of same. Materials and Methods: It was a prospective observational study done over a period of 1 year. A total of 100 term pregnant women with previous one lower-segment cesarean section (LSCS) fulfilling the criteria for a trial of labor were recruited for the study. As 23 patients refused to undergo trial of labor after cesarean (TOLAC) in early labor, 77 women formed the study group. Parameters assessed to predict successful TOLAC were maternal age, body mass index (BMI), history of prior vaginal delivery, interdelivery interval, indication of previous cesarean section, gestational age, type of labor, Bishop's score, and expected baby weight. Scores 0–2 were given, and the mean score obtained was correlated with the outcome of TOLAC. Results: Successful vaginal delivery occurred in 57.14% (44/77) of women. BMI ≤30 kg/m2 (P = 0.004), parity ≤ 3 (P = 0.005), Bishop's score >4 (P = 0.000), spontaneous onset of labor at the time of admission (P = 0.001), and nonrecurrent indication of previous LSCS (P = 0.029) were found to be significantly associated with the VBAC. The probability of having a successful VBAC was 83.3% and 100%, with the VBAC score value of more than 18 and 20, respectively. Conclusion: The mean VBAC score of 18–20 by the current scoring system is beneficial in predicting the outcome. This can help in counseling the patient, relatives as well as health professionals to undergo labor trial to decrease the cesarean section rate in the current era.
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Assessing the coverage of the pradhan mantri jan arogya yojana scheme and out-of-pocket expenditure in Mysore Urban slum dwellers p. 22
Vijaylakshmi Rao Vadaga, Deepak Anil, Shabeena Akbar, M R Narayana Murthy, Sunil Kumar Doddaiah
Introduction: In 2018, the Government of India launched the Pradhan Mantri Jan Arogya Yojana (PM-JAY), a part of the Ayushman Bharat scheme as a progressive step toward universal health coverage. The scheme was intended to provide health insurance for the socioeconomically deprived population. This study was undertaken to assess the coverage of the scheme and to assess the reduction in medical out-of-pocket expenditure (OOPE). Methods: This was a cross-sectional study conducted among the urban slum dwellers in Mysuru. A semi-structured questionnaire was used for the study. Oral consent was taken from the participants before administering the questionnaire. Data were collected by face-to-face interviews. Statistical tests such as percentages and mean were calculated using SPSS software (Version 26, Licensed by JSSAHER). Results: The study was conducted among 104 individuals, of which 73% were females. Only 38 (33%) of the participants had PM-JAY cards while 59 (56.73%) did not have any health insurance. Thirty percentage (78.95%) of the card holders had utilized the insurance in the past 1 year and incurred an OOPE of Rs. 25,873/-. For all the cardholders, this amount was spent from their savings. Conclusion: The coverage of the scheme and OOPE reduction toward health care is still lacking. Greater measures need to be taken by medical officers, medicosocial workers, and other field workers to identify eligible households and help them avail the benefits of this scheme.
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Perception of beneficiaries regarding quality of care and respectful maternity care being provided in delivery room using LaQshya guidelines p. 26
Chandra Gopal Dogne, Jitendra Dudi, Nalini Dogne, Sana Afrin, Abhay Singh, Deepa Raghunath, Salil Sakalle, Vinoth Gnana Chellaiyan
Introduction: Quality of care in labor room and maternity operation theatre is crucial so that every pregnant woman receives the most appropriate care with dignity and respect, which is her fundamental right. The present study was attempted to assess the satisfaction of beneficiaries of both rural and urban areas visiting the public health facilities with regard to the quality of care and Respectful Maternal Care (RMC). Methodology: The present study was carried out in the Department of Community Medicine, MGM Medical College Indore to assess the satisfaction of beneficiaries of both rural and urban areas visiting the public health facilities with regard to the quality of care and Respectful Maternity Care (RMC) for 1 year from June 2020 to June 2021. A scoring system was used and based on the perception of the beneficiaries on different parameters on the scale of 1–5 where 1 – poor, 2 – satisfactory, 3 – good, 4 – very good, and 5 was considered excellent. Results: The majority of beneficiaries were in the age group of 21–30 years. Statistically significant difference between rural and urban areas in parameters of beneficiaries with regards to various aspects of post-natal care, in parameter of explanation of treatment procedure, maintenance of privacy efforts put to not allow to feel lonely and treatment with dignity and respect between rural and urban areas. Conclusion: When all the parameters and subparameters of the perception of beneficiaries of quality of care and respectful maternity care (RMC) were analyzed in both rural and urban areas, statistically significant difference was observed.
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Bacteriological profile and antibiotic susceptibility patterns of Gram-negative bacilli isolated from lower respiratory tract infections p. 31
Divya Atray, S Sheethal
Background: Lower respiratory tract infections (LRTIs) are one of the most frequent infections seen in humans. Bacterial etiology of these infections is one of the major causes of morbidity and mortality. The emergence of drug resistance among bacteria is increasing throughout the world causing more severe infections because of their continuous mutation and multidrug resistance nature. Objectives: This study was focused on obtaining a comprehensive insight into the Gram-negative bacillary profile of LRTIs, their prevalence, and their antibiotic susceptibility patterns. Materials and Methods: The study was conducted for a duration of 6 months. Samples were obtained from patients of all ages and both sexes presenting with symptomatology suggestive of LRTIs. Following conventional culture, the isolated organisms were identified by various preliminary identification methods and biochemical tests. Antimicrobial sensitivity testing of Gram-negative isolates was performed by standard methods as recommended by CLSI 2019. Results: Out of the 1724 LRT specimens evaluated, 307 (17.80%) were culture positive. Our study showed that Gram-negative bacilli are the predominant cause (97.70%) of LRTIs with Klebsiella pneumoniae (42%) as the major pathogen followed by Escherichia coli (31.66%), Pseudomonas aeruginosa (25.33%), and Acinetobacter baumannii (1%). Extended-spectrum beta-lactamase production was detected in 3.33% and metallo-beta-lactamase in 2% of the total GNB pathogens. Conclusion: For effective management of LRTIs, an ultimate and detailed bacteriological diagnosis along with antimicrobial susceptibility testing is required to overcome the global problem of antibiotic resistance.
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Loneliness, social support networks, mood, and well-being among the community-dwelling elderly, Mysore p. 37
Meghana Narendran, Renuka Manjunath, M R Narayana Murthy
Background: Humans are social beings. Older adults more commonly endorse social engagement than physical health when describing successful aging. Deficits in social support have been associated with a wide variety of adverse health outcomes in older age, ranging from physical health to depression and self-harm. In this study, we attempt to identify the relative contributions of subjective social isolation (loneliness) and objective social isolation, measured as support network type, to depression and well-being among the community-dwelling elderly. Therefore, the objective of the study was to estimate the prevalence of loneliness and depression and to know the relationship between social network type, loneliness, and depression among the community-dwelling elderly. Subjects and Methods: A cross-sectional study was done for a period of 6 months. Individuals aged 60 years and above were included and severely ill and bed-ridden patients were excluded from the study. Sampling method used was population proportion to size with sample size of 290. The participants were interviewed using a semistructured questionnaire, where demographic and personal data and social network pattern were collected. Depression was assessed using the Geriatric Depression Scale. Data were analyzed using Statistical Package for the Social Sciences Software, 22.0 version. Descriptive statistics like percentage, mean, and standard deviation were applied. Inferential statistical tests such as the Chi-square test were applied to find out the association and expressed it as statistically significant at a P value < 0.05. Results: Among the study participants, 44.3% were lonely, 19.4% felt hopeless, and only 38% felt satisfaction in life and happiness. "Suggestive Depression" was seen among 48.6% and "Persistent Depressive Mood" was seen in about 20.2% of participants. Loneliness explained the excess risk of depression in the widowed. Similarly, 38.2% had a nonintegrated social network and 32% had integrated social network who also reported being lonely. Conclusion: Loneliness and social networks both independently affect mood and well-being in the elderly, underlying a very significant proportion of depressed mood.
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Intractable vomiting: An interesting case p. 42
Khyati Thapliyal, Ashutosh Garg, Vivek Pal Singh
Nausea and vomiting constitute one of the most common presenting symptoms in a variety of diseases in clinical practice. Recurrent vomiting can be due to simple gastritis which may lead to dehydration and electrolyte disturbances to threatening intracranial hypertension. Prolonged recurrent vomiting can also lead to malnutrition. Esophageal dysmotility is usually associated with dysphagia but is infrequently associated with recurrent vomiting. We report a case of acute-onset intractable vomiting in a 50-year-old Indian female who presented with severe dehydration and hypernatremia. A timed barium esophagogram revealed dilated esophagus with a rat-tail appearance. Upper gastrointestinal endoscopy revealed dilated esophagus with a tight esophageal-gastric junction. With a diagnosis of achalasia cardia, the patient underwent peroral endoscopic myotomy with complete resolution of symptoms.
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A focal submucosal lipomatosis: An extremely rare cause of appendicitis p. 45
Shirish Sahebrao Chandanwale, Payal Patel, Anubhaw Verma, Nirali Patel
Gastrointestinal lipomatosis is less frequent condition and it differs from lipoma due to the lack of capsule. The most common location of gastrointestinal lipomatosis is colon, followed by the ileum and jejunum. Isolated lipomatosis of the appendix is rare. It can be diffuse, asymmetric, or focal. In the localized form, only few patients present with symptoms. Obstruction of the lumen of the appendix is thought to be the primary pathology of appendicitis. Various pathologies such as hard fecal mass, stones, lymphoid hyperplasia, and neoplasia have been implicated. Obstruction of the appendiceal lumen due to isolated submucosal lipomatosis of the appendix is extremely rare. It can be one of the causes of appendicitis. Although radiological modalities such as ultrasonography, computed tomography scan, and magnetic resonance imaging are used for diagnostic workups, definitive diagnosis requires histopathological examination.
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The dark areas of esophagus: Esophageal melanocytosis p. 47
Tameem Afroz, Sistla Radha, B Sivananda Reddy, Mohammed Umar Amaan
Esophageal melanocytosis characterized by melanocytic proliferation in the epithelium of esophagus is extremely rare disease. Aberrant migration of melanocytes during embryogenesis occurs in a small number of cases. Hence, the occurrence of benign and malignant melanocytic lesions is now known entities in esophagus. Melanocytosis is a benign entity and is very rare with an incidence of 0.07%–2.1%. The etiology of these lesions is not known. Endoscopic, histologic, and staining characteristics of two lesions are described. These cases were diagnosed from 450 endoscopic biopsies studied over a period of 10 months.
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Reversible brain death: A rare manifestation of snake envenomation p. 50
Ankusha Patra, Vrinda Goel, Shiva Narang, Amitesh Aggarwal
Snakebite is a serious public health problem and one of the priorities in WHO's list of neglected tropical diseases. It significantly increases morbidity and mortality associated with envenomation in India. A neurotoxic snakebite can present in the form of symptoms ranging from asymptomatic presentation, ptosis, and complete external and internal ophthalmoplegia to complete respiratory failure. This is a case report of a 22-year-old male, who presented with bilateral ptosis and impending respiratory failure. He soon became deeply comatose, with absent brain stem reflexes (mute plantar, fixed pupils, and the absence of the doll's eye reflex) which were suggestive of brain death. He was treated with polyvalent anti-snake venom, anticholinesterases, and supportive therapy and recovered completely with an excellent outcome.
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Syncope and QT prolongation associated with the use of herbal product and m-RNA vaccination in a young woman p. 53
Osman Pirhan, Cennet Yildiz
Herein, we report a case of a 31-year-old woman with syncope due to QT prolongation 36 h after the second dose of Pfizer-BioNTech vaccination. During her comprehensive history taking, she admitted the use of herbal preparation. Her initial electrocardiogram showed a QTc interval of 690 ms, and she was interned to the intensive care unit (ICU). Her biochemical findings revealed no evidence of electrolyte abnormalities, and oral propranolol was started. During ICU monitorization, she developed polymorphic ventricular tachycardia, which subsequently degenerated into ventricular fibrillation. Genetic investigation identified KCNQ1 mutation, and ICD implantation was performed. The patient was discharged with mexiletine and propranolol treatment, and the outpatient clinic follow-up was recommended.
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Anti-N-methyl-D-Aspartate-Receptor encephalitis following herpes simplex virus encephalitis – Presenting as a pediatric patient with abnormal movements and psychiatric manifestation p. 56
Sravani Kolla, Lokeswari Balleda, Chandrasekhara Reddy Thimmapuram
Herpes simplex virus (HSV) encephalitis remains one of the more severe forms of childhood encephalitis. The clinical course of HSV encephalitis is usually monophasic but occasionally complicated by a clinical relapse, causing biphasic illness. Sometimes relapse may be due to secondary immune mechanisms. Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an example of immune-mediated relapse following herpes encephalitis. This is still underrecognized, with probable grave consequences if not treated early. Our index case was an 8-year-old male child with severe generalized choreoathetosis and behavioral disturbances, presented 4 weeks after documented HSV encephalitis. Cerebrospinal fluid (CSF) was positive for anti-NMDA receptor antibodies. The diagnosis was confirmed and treated with intravenous (IV) immunoglobulins (2 g/kg) and IV pulse-dose methylprednisolone (30 mg/kg) for 5 days. Other supportive management included tablet revocon 25 mg (tetrabenazine) ¼ tablet BD, clonazepam 0.25 mg one tablet BD, and syrup sizodon (risperidone) 0.5 mg BD. The patient is on regular follow-up and is recovering well but slowly. Patients with relapsing symptoms following HSV encephalitis or prolonged atypical symptoms, with repeat CSF-negative polymerase chain reaction for HSV should routinely be tested for NMDA receptor immunoglobulin G antibodies in CSF and/or serum. It is important to be aware of this differential diagnosis because patients respond well to immunotherapy.
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Acute bilateral retrobulbar optic neuritis revealing sphenoethmoidal sinus neuroendocrine carcinoma p. 60
Belfaiza Soukaina, Marion Chatain, Benjelloul Fatiha
Primary sinonasal neuroendocrine carcinoma is a rare tumor of extreme malignancy. The diagnosis is often made at an advanced stage. The most recently documented treatment for nonmetastatic paranasal sinus neuroendocrine carcinoma consists of chemotherapy (cisplatin-VP16) followed by radiotherapy. Surgery is reserved for resectable tumors that do not respond well to chemotherapy. We report the case of a patient admitted for acute bilateral Retrobulbular optic neuropathy (RBON) revealing a sphenoethmoidal sinus neuroendocrine carcinoma.
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Single-shot segmental thoracic spinal anesthesia for a giant lipoma of the back of the chest p. 63
T Kumar Venkatesh, S Parthasarathy
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Managing chronic obstructive pulmonary diseases in 2023 – What is new? p. 65
Vidushi Rathi, Nitesh Gupta, Manu Madan, Pranav Ish
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