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ORIGINAL ARTICLES
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
DOI:10.4103/INJMS.INJMS_4_19  
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.
  8 1,988 217
REVIEW ARTICLES
Sources and toxicological effects of lead on human health
Bikash Debnath, Waikhom Somraj Singh, Kuntal Manna
April-June 2019, 10(2):66-71
DOI:10.4103/INJMS.INJMS_30_18  
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.
  8 5,702 522
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
DOI:10.4103/INJMS.INJMS_36_18  
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.
  6 4,522 480
ORIGINAL ARTICLES
Cardiac manifestations in dengue
Parag Viren Papalkar, Rajesh R Sarode, Sourya Acharya, Sunil Kumar
January-March 2019, 10(1):30-34
DOI:10.4103/INJMS.INJMS_34_18  
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.
  3 2,019 274
CASE REPORTS
Presternal bronchogenic cyst: A rare presentation
Suhas Jajoo, Samarth Shukla, Sourya Acharya
April-June 2019, 10(2):105-107
DOI:10.4103/INJMS.INJMS_32_18  
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.
  2 1,342 156
ORIGINAL ARTICLES
Nail fold capillaroscopic changes in patients with type 2 diabetes mellitus: An observational, comparative study
Deepak Jakhar, Chander Grover, Archana Singal, Gopal Krushna Das, SV Madhu
January-March 2020, 11(1):28-33
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.
  2 1,637 196
REVIEW ARTICLES
Hematological profile in COVID-19, whether it matters in children
Purnima Margekar, Ashok Kumar, Venu Gopal Margekar, Shubha Laxmi Margekar
January-March 2021, 12(1):11-14
DOI:10.4103/injms.injms_141_20  
Coronavirus disease 2019 (COVID-19) is an acute respiratory and systemic illness, and is a public health emergency which has involved all the continents. Though limited data is available for infection in pediatric population, infection seen in children is of milder form. During this pandemic, documentation of laboratory predictors to discriminate between mild and severe forms of this infection would be helpful. Various hematological parameter alterations in the pediatric COVID-19 cases show anemia, thrombocytopenia, eosinopenia, and inconsistent leukocyte indices. It may be too early to say right now as to what extent will these alterations help us in outlining the severity of disease or transmission of disease. However, it will be pertinent to understand these abnormalities, and keep track of them, so as to understand the disease, as the pandemic unfolds.
  2 1,035 99
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
DOI:10.4103/INJMS.INJMS_40_18  
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.
  2 3,402 421
CASE REPORTS
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
DOI:10.4103/INJMS.INJMS_6_18  
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.
  1 1,445 140
Acute quadriplegia: An interesting case with etiological and pathophysiological disparity
Vivek Pal Singh, Jai Khullar, Ashutosh Garg, Anil Vardani
July-September 2019, 10(3):162-165
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.
  1 1,524 153
Area postrema syndrome: A lesser known variant of neuromyelitis optica spectrum disorder
Gaurav Kumar Mittal, Shilpa Sekhar, John Jacob Mathew, Jennifer Singhdev
October-December 2019, 10(4):222-224
DOI:10.4103/INJMS.INJMS_124_19  
One of the most specific presentations of neuromyelitis optica spectrum disorders (NMOSDs) is area postrema syndrome (APS). Although NMOSDs are now being increasingly encountered, APS is rarely reported in literature. With the emergence of the ever-expanding spectrum of neuromyelitis optica (NMO) comes various challenges in the prompt recognition, confirmation, and swift initiation of the therapy. Although with the new consensus criteria of the International Panel of NMO Diagnosis 2015, the earlier challenges of diagnosis have been removed to a great extent, still there is a long road ahead in the widespread dissemination of the current knowledge of NMOSD among health-care professionals in India. We hereby report a case of APS in a young female with endeavor to increase the awareness of this peculiar kind of presentation from India.
  1 1,835 187
EDITORIAL
Unlocking the mental health crisis in health-care providers during COVID-19 pandemic
Jasmine Parihar, Kirat Grewal
October-December 2020, 11(4):173-174
DOI:10.4103/injms.injms_123_20  
  1 952 78
LETTERS TO THE EDITOR
Cortical blindness in posterior reversible encephalopathy syndrome in postpartum eclampsia
Sonakshi Singhal, Amit Baheti, Kirti Singh, Sourya Acharya, Neema Acharya
October-December 2019, 10(4):229-230
DOI:10.4103/INJMS.INJMS_123_19  
  1 884 112
ORIGINAL ARTICLES
Evaluation of clinico–Radiological profile and correlation with ultrasonography of the chest in coronavirus disease 2019 pneumonia
Sudhir Bhandari, Ajeet Singh, Meenu Bagarhatta, Govind Rankawat, Amitabh Dube, Shivankan Kakkar, Amit Tak
April-June 2020, 11(2):70-75
DOI:10.4103/INJMS.INJMS_55_20  
Background: The present study was undertaken to investigate imaging features of emerging coronavirus disease 2019 (COVID-19) pneumonia by chest ultrasound point-of-care ultrasonography (POCUS) and digital radiographs (chest radiograph [CXR]) and their correlation with clinical manifestation and severity of the disease. Methods: The present ongoing single-center study assessed patients admitted from April 20 to May 15, 2020, with laboratory-confirmed COVID-19 pneumonia at SMS Medical College Hospital, Jaipur, India. The clinical features, laboratory investigations, CXR, and POCUS findings were evaluated and compared. Results: Fifty-two patients with a manifestation of COVID-19 pneumonia were studied. Most of the patients were in the fifth and sixth decade of age group with a mean age of 56.57 years. There was an overall male preponderance (80% men and only 20% women). All pneumonitis patients were symptomatic with fever (88.46%), cough (82.69%), and dyspnea (55.77%) being the major symptoms. Thirty-four patients had underlying comorbid conditions. The digital radiograph-chest findings of 55.77% patients exhibited classic COVID-19 pneumonia findings. The ultrasonography of the chest findings revealed pleural and lungs changes in 94% of patients with COVID-19-positive pneumonia. CURB-65 score for the severity of pneumonia had a positive correlation with POCUS severity score and CXR visual score with P = 0.0013 and 0.0018, respectively. The duration of some major symptoms for COVID-19 pneumonia also had a positive correlation with the POCUS severity score and CXR visual score. Conclusion: The spectrum of COVID-19 pneumonia has a predilection for advancing age and male gender. Although both POCUS and CXR are important tools to detect severity of pneumonia, POCUS has higher sensitivity as compared to that of CXR to detect characteristics of COVID-19 pneumonia, especially interstitial involvement or acute respiratory distress syndrome.
  1 1,819 228
Prediscussion and Postdiscussion Assessment Scores in a Self-directed learning module implemented in the department of biochemistry: A comparative study
Poonam Agrawal, Niket Verma
April-June 2020, 11(2):81-84
DOI:10.4103/INJMS.INJMS_153_19  
Background: Self-directed learning (SDL) is an important tool for transforming medical students into lifelong learners so that they are competent to identify their learning needs, allocate resources, and evaluate the learning process throughout their career. Recently, the Medical Council of India has introduced SDL as an essential component of the competency-based medical education curriculum and has allocated fixed hours for SDL in all undergraduate MBBS students. Regarding the role of facilitators in SDL program, there are controversial reports and there are even studies which have shown that the role of a facilitator is not important. Aim: The proposed study aimed to assess students' performance before and after discussion in an SDL module in small-group teaching–learning method and compare the performance scores. Methodology: A total of 117 students responded and were included in the study. Batch A had 59 students and Batch B had 58 students. The topic selected for the SDL module was “Heme degradation and Jaundice.” The module was conducted over two contact sessions, Session 1 and Session 2, which were conducted 5 days apart. The prediscussion and postdiscussion assessment questionnaire was also prepared. Session 1 was conducted during a 1-h SDL slot. A gap of 4 days was given to students for doing self-study and to learn the topic. The prediscussion questionnaire consisting of five multiple-choice questions related to the topic was shared with the students a day before the second contact session. Session 2 was conducted during the 2-h tutorial slot (over 2 consecutive days for two batches of the class, Batch A and Batch B, respectively). Fishbowl method of small-group teaching–learning was done followed by postdiscussion questionnaire. Results: The questionnaire was analyzed, and it was observed that the overall mean performance of students improved considerably (78.3%–87.7%) in the questions related to core concept (Q1, Q2, and Q3). Similarly, in the questions related to clinical aspects of the topic, the mean performance of students showed considerable improvement from prediscussion to postdiscussion assessment (86%–93.5%). Conclusion: We conclude that the SDL module should be meticulously planned keeping in mind the topic selected and the availability of infrastructure and workforce. Peer discussion is a very important aspect of the SDL module, and it shows improvement in learning outcomes in an SDL module.
  1 1,217 139
Worldwide incidence and mortality of bladder cancer and human development index: An ecological study
Elham Goodarzi, Malihe Sohrabivafa, Ali Hasanpour Dehkordi, Zaher Khazaei
April-June 2020, 11(2):88-97
DOI:10.4103/INJMS.INJMS_108_19  
Background and Objective: Bladder cancer (BC) is the most common cancer of the urinary and genital tract. Many factors, including environmental and socioeconomic factors, also affect the incidence and mortality of BC. The aim of this study was to evaluate the epidemiology of BC incidence and mortality worldwide based on the data extracted in 2018. Materials and Methods: The present study is a descriptive-analytic study that extracts the incidence and mortality rates of cancer from the World Bank in 2018. The incidence and mortality rates and BC distribution maps were drawn for world countries. To analyze data, correlation test and regression tests were used to evaluate the correlation between the incidence and mortality with the Human Development Index (HDI). The statistical analysis was carried out by Stata-14 and the significance level was estimated at the level of 0.05. Results: The results showed a positive and statistically significant correlation between the incidence (r = 0.587, P < 0.0001) and mortality (r = 0.271, P < 0.001) of BC with the HDI index. The results showed that there was a positive correlation between the incidence of BC with Gross national income per 1000 capita (GNI) (r = 0.405, P < 0.001), mean years of schooling (MYS) (r = 0.525, P < 0.001), life expectancy at birth (LEB) (r = 0.566, P < 0.001), and expected years of schooling (EYS) (r = 0.574, P < 0.001). In addition, there was a positive and statistically significant correlation between mortality rate with GNI/1000 capita (r = 0.186, P < 0.01), MYS (r = 0.227, P < 0.01), LEB (r = 0.305, P < 0.01), and EYS (r = 0.250, P < 0.01). Conclusion: Given that the incidence and mortality of BC in high-HDI countries is higher, more research in these countries is needed to identify the factors affecting the incidence of disease in these countries. We can perform prophylactic actions to prevent the incidence and mortality of this cancer by identifying the risk factors of the aforementioned disease.
  1 1,314 102
Etiological spectrum of drug-resistant epilepsy – A glimpse from North East India
Baiakmenlang Synmon, Shri Ram Sharma, Musharraf Hussain, Yasmeen Hyniewta
July-September 2020, 11(3):127-131
DOI:10.4103/INJMS.INJMS_78_20  
Introduction: Drug-resistant epilepsy (DRE) occurs in 20%–30% of all epilepsy patients. This group of patients is a clinical challenge and needs a multidisciplinary approach to achieve the etiological diagnosis and also guide their treatment protocol.Materials and Methods: A retrospective study was conducted at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) in the Northeastern region of India, where patients fulfilling the definition of DRE were followed up to establish an etiological diagnosis. Clinical and drug history was taken for these patients. Electroencephalogram and neuroimaging were done in all patients. An attempt to evaluate the various etiologies causing DRE was made.Results: Thirty-three patients were included in the study after the exclusion of pseudo-resistance. Seventeen males and 16 females were included with the age range of 2–57 years. The most common clinical semiology was focal seizure with dyscognitive features seen in 16 patients. The most common etiology documented was medial temporal lobe epilepsy seen in ten patients.Conclusion: DRE is a common entity seen in this part of the country where epilepsy surgery is still out of reach. Etiology needs to be established in these groups of patients as other modes of therapy can be offered which include surgical and other interventions other than optimal drug therapy.
  1 876 100
Factors affecting quality of sleep in hospitalized patients: A cross-sectional survey in a tertiary care hospital
Ovine Loyster D souza, Irene T. R. Alvares, Manjeshwar Shrinath Baliga
October-December 2019, 10(4):201-206
DOI:10.4103/INJMS.INJMS_17_19  
Background: Sleep is very important for humans and more so to hospitalized patients. Alterations in the normal sleep pattern have negative impact on the medical conditions, mental health, cognitive performance and recovery of the hospitalized individuals. The primary aim of this study was to assess the quality of sleep among hospitalized patients and to find the correlation between the factors affecting sleep and sleep quality. The secondary objective was to understand the quality of sleep in people admitted for surgical and medical treatment. Methods: In this cross-sectional study, the hospitalized patients were examined. Sleeping habits of 100 inpatients of surgical and clinical wards were assessed through the Pittsburgh Sleep Quality Index (PSQI). A self-designed questionnaire was also used to ascertain the factors affecting the sleep. Content validity and test–retest reliability were evaluated. The data obtained were analyzed by the statistical methods of frequency, percentage, and Chi-square. Results: The cross-sectional study showed that the mean score for PSQI was 7.58 ± 3.14 and that 69% of the patients had poor sleep as inferred from the global PSQI >5 scores. Age and gender had no effect on the PSQI total score, but the number of roommates, type of the ward, hospitalization period, presence and severity of pain, taking sleep medication, and attitude toward the overall atmosphere and interior of wards has caused deviation in scores. Conclusion: Sleep problems are quite frequent in medical inpatients. Pain management and modification of the ward interior and atmosphere can impact inpatients sleep quality.
  1 2,792 326
Seroprevalence of hepatitis B infection among pregnant women in Southern Odisha
Neha Samal, Sanghamitra Padhi, Laxmi Burman
October-December 2019, 10(4):207-209
DOI:10.4103/0976-2884.269474  
Background: Hepatitis B virus (HBV) infection continues to be a life- threatening health problem throughout world, infecting more than two billion people. While blood transfusion and unsafe therapeutic injection continue to be major risk factors, the role of vertical transmission remains under- estimated. Hence, this study was done to find out the prevalence of HBV infection and associated risk factors among healthy pregnant ladies in Southern Odisha. The present study was a prospective, observational study conducted, in the department of Microbiology, with collaboration of department of Obstetrics and Gynecology of MKCG Medical college from 1st March 2017 to 28th Feb 2018. Methodology: After collection of three to four millilitre of venous blood from the clients, sera was separated by centrifugation. They were then tested for Hepatitis B surface antigen (HBsAg) by Enzyme linked Immunsorbent assay (ELISA). Serological status of the subjects and correlation with their socio-economic characteristic was noted using a preset proforma. Babies born to HBsAg positive ladies were administered Hepatitis B vaccine and immunoglobulin. Results: Total 3,230 in non-duplicating serum samples were screened among which 150 (4.64%) were tested positive for HBsAg. Ladies with multiple sexual partners (57. 14%) followed by intravenous drug users (7.88%) were mostly positive for HBsAg. Conclusion: Exposure to risky social behavioural pattern, lack of awareness could be suggested as possible means of acquiring the infection. Immunization is the most effective and only way of preventing development of chronic carrier state. Hence all neonates were administered with hepatitis B vaccine and 0.5 ml of hepatitis B immunoglobulin within 12 hours of birth.
  1 1,399 171
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
DOI:10.4103/INJMS.INJMS_1_18  
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.
  1 2,248 278
Implementation of antimicrobial stewardship activities in India
Arzoo Sahni, Arti Bahl, Rashi Martolia, Sudhir Kumar Jain, Sujeet Kumar Singh
January-March 2020, 11(1):5-9
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.
  1 2,697 409
Stress-related disorders in health-care workers in COVID-19 pandemic: A cross-sectional study from India
Surabhi Mathur, Divya Sharma, Ram Kumar Solanki, Manish Kumar Goyal
October-December 2020, 11(4):180-184
DOI:10.4103/INJMS.INJMS_77_20  
Background: The coronavirus disease-2019 (COVID-19) outbreak, first detected in Wuhan, China, has turned into a rapidly spreading pandemic ailing the human race throughout the world. Health-care workers (HCWs) are under immense physical and psychological pressure, adversely affecting their efficiency and decision making. Aim: We hereby intend to study the impact of COVID-19 pandemic in HCWs in reference with a variety of factors. Materials and Methods: A nationwide cross-sectional online study using semi-structured pro forma along with the Adjustment Disorder New Module and the Depression, Anxiety, and Stress Scale-21 was conducted among 200 respondents. Results and Discussion: Of the 200 respondents, 174 (87%) were doctors and 26 nursing staff, with a mean age of 42.1 ± 12.2 years, 62% were male, and 63% were working in the government sector. A significant number of respondents were found to be suffering from acute stress (9.5%), depression (17%), and anxiety (19.5%) which they attributed to the negative professional and personal influence of this ongoing pandemic scenario. HCWs on the front lines of this pandemic are facing compounding stressors and need robust psychiatric help to adequately take care of this need.
  1 1,434 176
Burnout of resident doctors in a teaching hospital in Jordan
Raed Nael Mohammad Al-Taher, Mohamad E Mahseeri, Rawan Abd AlMohsen Mohammad Al Habashneh, Moaath Alsmadi, Amal Ibrahim Abd Al Qader Abu Harb, Nadwa Basem Basheer Bustami, Awni D Shahait, Lana Alghanem, Fadi Alhalasa, Farah Moh'd Bassam Mutlaq Al Muhtaseb, Murad Mohammad Subhi Qirem, Shahd Maher Abdel Rahman Yaghi
October-December 2020, 11(4):192-196
DOI:10.4103/INJMS.INJMS_81_20  
Background: Burnout syndrome in the medical field recently gained much attention, becoming an essential factor in specialty selection and job satisfaction. In this study, we focus on evaluating the emotional distress among residents of various specialties at a tertiary hospital and associated factors. Methods: This is a cross-sectional study which was done using a sociodemographic questionnaire among residents of various specialties. The collected answers were assessed using Student's t-test and Chi-square test for continuous variables and categorical ones respectively. Results: A total of 250 out of 382 registered residents took the survey with a response rate of 65%, 48% were female, 67.1% single, mean age 27.5 ± 2.2, and mean weekly duty work was 71.8 ± 22.6. 53.6% of residents reported a high grade of emotional exhaustion. Furthermore, 82.4% of the residents exceeded the 24-shift length, reaching a maximum of 56 h straight in-house duty. Male residents reported a higher rate of feeling pressured to work, while female residents reported that they would learn more effectively and commit fewer errors if they slept more. Conclusion: This is the first Jordanian study to measure elements leading to resident emotional distress and its effect on personal achievement. The prompt recognition of risk factors is essential for the achievement of prophylactic actions against resident emotional distress, which can be minimized by a well-defined regulation for residency working hours.
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REVIEW ARTICLES
Global trends of clinical presentation of COVID-19
Ragini Sharma, Mradul K Daga, Govind Mawari, Vijay Kumar Karra, Naresh Kumar, Manish Kumar Jha, Suresh Kumar
April-June 2020, 11(2):59-64
DOI:10.4103/INJMS.INJMS_25_20  
Emerging and reemerging diseases pose global challenges for public health. Pneumonia of unknown origin, given the name COVID-19, began in China in December 2019. On March 11, 2020, the WHO declared it to be a pandemic. Currently, the disease is booming rapidly and impacting the well-being of people and the economy of countries globally. Observational studies have somewhat highlighted clinical findings of the disease, but there are still no decisive data about its global trends. The purpose of this review is to bring to light the huge disparities in the clinical presentation of the disease among countries. The data for this review were obtained from studies pertaining to clinical, laboratory, and imaging features obtained from various journals. It was found that occurrence of the most frequently seen features ranged as – fever (98%–35%), cough (88%–25%), dyspnea (88%–4.8%), and sore throat (61%–8%). A definite reason for this is still obscure. This calls for more conclusive studies to investigate the possible causes of these trends. This might go a long way in increasing our understanding of the disease and improve its diagnosis and treatment.
  1 2,135 252
The race to find COVID-19 Vaccine: So near, yet so far!
Sonali Sachdeva, Udita Gupta, Anupam Prakash, Shubha Laxmi Margekar, Ritika Sud
October-December 2020, 11(4):175-179
DOI:10.4103/injms.injms_121_20  
In a brief span of time, coronavirus has become a major cause of concern worldwide ever since the first case was reported in Wuhan, China in December 2019. The pace at which the virus is being transmitted across the globe and the sudden increase in numbers of cases is much faster than severe acute respiratory syndrome and Middle East respiratory syndrome. With the rising number of cases, coronavirus disease 2019 (COVID-19) not only has an adverse effect on health, it has a deep seated impact on the economic and social front. Hence, the development of an effective vaccination strategy seems to be the only light at the end of the tunnel. The ongoing pandemic mandates the speedy evaluation of multiple approaches in order to elicit protective immunity and to curtail unwanted immune-potentiation which plays an important role in the pathogenesis of this virus. Being developed by more than 90 institutions in the world, a vaccine which is both effective and safe becomes all the more essential in the current time. Various types of vaccine strategies are being tested under different phases of clinical trials. The present paper hopes to provide an overview of the current work going on in this direction, with an aim to further fuel effects for an early and effective COVID-19 vaccine platform.
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* Source: CrossRef