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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.
  17 8,152 711
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 2,494 262
REVIEW ARTICLES
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.
  8 5,976 617
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.
  7 2,611 324
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.
  4 5,899 364
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.
  4 2,049 210
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.
  3 2,427 258
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.
  3 4,057 567
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 1,858 178
ORIGINAL ARTICLES
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.
  2 4,061 441
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.
  2 1,839 207
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.
  2 1,806 131
REVIEW ARTICLES
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 4,184 469
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 1,843 162
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 2,012 190
Idiopathic pulmonary hemosiderosis: A differential diagnosis of pulmonary tuberculosis in a young child
Shelley Shamim, Suptish Biswas, Suman Mandal
July-September 2019, 10(3):170-173
DOI:10.4103/INJMS.INJMS_44_19  
Idiopathic pulmonary hemosiderosis (IPH) is a rare disease diagnosed primarily in children and young adults, characterized by recurrent diffuse alveolar hemorrhage which leads to the deposition of hemosiderin-laden macrophages in the lung. It is a diagnosis of exclusion and requires a high level of clinical suspicion. It may remain undiagnosed for years, hence often mistreated. Here, we describe such a case of IPH in a 15-year-old male who was initially mistreated twice as clinically diagnosed pulmonary tuberculosis first with Category 1 and then Category 2 antitubercular drugs. He had a history of two episodes of hemoptysis, recurrent episodes of paleness, persisting weakness, and shortness of breath. He also had bilateral reticulonodular opacities on chest skiagram. His history raised the suspicion, the presence of hemosiderin-laden macrophages in bronchoalveolar lavage, and transbronchial lung biopsy strongly suggested the diagnosis. However, the final diagnosis came out after ruling out all the probable causes.
  1 1,782 167
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 2,397 231
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 1,178 143
Immunomodulatory effect of amphotericin B enhances antiviral activity
Falah Hasan Obayes AL-Khikani
April-June 2020, 11(2):111-112
DOI:10.4103/INJMS.INJMS_34_20  
  1 930 89
ORIGINAL ARTICLES
Adoption and validation of the adolescent stress questionnaire for Indian high school students
Ovine Loyster D Souza, Sucharitha Suresh, Manjeshwar Shrinath Baliga
October-December 2019, 10(4):210-218
DOI:10.4103/INJMS.INJMS_42_19  
Introduction: Adolescent stress questionnaire (ASQ) – a 58-item inventory covering broad range of adolescent distress was developed and validated for Australian adolescents. The present study reports a modification of the ASQ for the Indian context. Methodology: Initially, a focus groups study was carried out with 8 adolescents and 8 experts to understand the relevance of the subject and domain contents of ASQ using the original ASQ. Later content validation was done by the experts in the field for the modified ASQ. The modified version was administered to (n = 20) adolescents for pilot testing. In the next stage, the scale was given to 153 adolescents and readministered to the same samples after 1 week. Statistical analysis was done to ascertain the internal consistency, component factor, and test–retest reliability as per the standard analysis. Results: During stage one, 38 questions were retained which were more relevant to Indian context. The internal consistency of 6 subscales was ≥8 and measuring 0.89 for overall questionnaire. The test–retest reliability measured 0.96 for the overall scale (P < 0.0001) for each domain. During the confirmatory factor analysis, above half (20 of 38) of the items confirmed high correlations with their component scale, with factor loadings P < 0.5. Conclusion: The modified ASQ had acceptable internal consistency and test–retest reliability. Further testing with adolescent students living in other parts is recommended to provide a more complete assessment of the questionnaire.
  1 3,983 292
Clinicodemographic profiling of zika outbreak in Jaipur, Rajasthan
Raman Sharma, Madhulata Agarwal, Mayank Gupta, Ruchi Singh, Sunil Kumar Mahavar, Rajni Sharma, Deepa Meena
October-December 2019, 10(4):184-189
DOI:10.4103/INJMS.INJMS_65_19  
Background: The 2018 postmonsoon outbreak of Zika virus infection, in a localized pocket of city of Jaipur, Rajasthan, so far the largest in India, alarmed the health authorities to optimize surveillance and measures. Hence, a community-based study to analyze the clinicodemographic profile was conducted to gain better understanding of its squeal. This study aimed to analyze the clinicodemographic profile of this new entrant viral infection. Methods: The study was designed as a community-based observational study. 1,488,870 people in vicinity of the index case were surveyed clinically from October to November 2018. A total of 1925 febrile individuals including pregnant ones in various trimesters of their pregnancy were screened for Zika infection by reverse-transcriptase-polymerase-chain-reaction (RT-PCR). Among these, 153 were RT-PCR positive and 111 cases consenting for the study were included and data collected were analyzed using SPSS 16 software. Results: The mean age of the study population was 27.51 years (95% confidence interval = 24.78–30.25), 53% of the patients were females. Out of 59 Zika-positive females, 27 (46%) were pregnant; 12 (44.4%) were in first trimester and 9 (33%) and 6 (22.2%) in second and third trimester, respectively. The incubation period ranged from 2 to 10 days, the most common symptom being low grade fever in 82%, followed by myalgia in 64.9% and arthralgia in rheumatoid distribution in 55.9%. On examination, a widely distributed blanching maculopapular rash was seen in 28.8%; nonpurulent conjunctivitis differentiating it from dengue was seen in 16.2%. Conclusions: Although Zika, a commonly prevalent virus in dengue endemic belts, yet unknown to our territory, usually causes a mild febrile illness, it can be a cause of intense apprehension to many if infection occurs in the first trimester of pregnancy. Formulating guidelines to tackle Zika pregnancy is a daunting task and needs collaboration across the globe to carry out future research and to get the knowhow.
  1 1,804 203
Clinical and laboratory profile of COVID-19 patients admitted at a tertiary care center in New Delhi and assessment of factors predicting disease severity
Piyush Jain, Nitin Sinha, M K Hari Prasad, Vaibhav Padole
Ahead of print schedule 0, 0(0):0-0
DOI:10.4103/injms.injms_158_20  
Background: This study was conducted in nonintensive care unit COVID-19 patients admitted in a tertiary care center, to assess the clinical profile and find surrogate markers to predict the severity of COVID-19 at the time of admission. Methodology: It is a cross-sectional observational study. Clinical and laboratory data were compiled of patients admitted in COVID wards in a tertiary care center. Patients were stratified clinically according to the severity of COVID pneumonia. The admission clinical and laboratory parameters were compared between the severe and nonsevere COVID patients. Results: The study included 63 patients of which 46 were males, with a mean age of 47 years. Patients were classified into mild (32%), moderate (19%), and severe (49%) categories according to national guidelines. Fever (81%), cough (67%), and dyspnea (67%) were the most commonly observed symptoms. In comparative analysis, mean C-reactive protein (CRP), serum ferritin, and neutrophil–lymphocyte ratio (NLR) were significantly higher in severe COVID-19 patients and the admission PaCO2 significantly lower compared to nonsevere patients. Conclusion: The study shows that raised NLR, CRP, serum ferritin, and low PaCO2 levels at the time of admission are important predictors of disease severity.
  1 442 24
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 3,050 351
Effect of exercise training on dimensions of quality of life and fatigue in people with congestive heart failure class II and III: A randomized controlled trial
Ali Hasanpour-Dehkordi, Mitra Yadollahi, Shahriar Salehi Tali, Reza Ghanei Gheshlagh
January-March 2020, 11(1):15-20
DOI:10.4103/INJMS.INJMS_43_19  
Background: Improved living conditions and increased life expectancy have led to aging in societies. Increased incidence of chronic heart disease is one of the most important economic, social, and health challenges of the 21st century. Aim: This study aimed to examine the effect of exercise training on dimensions of quality of life and mental status in people with congestive heart failure Class II and III. Materials and Methods: This study was carried out on patients with chronic heart failure. For this purpose, 52 eligible patients were chosen and randomly divided into case and control groups. The participants in the case group were asked to follow an exercise program three sessions per week in the morning for 24 weeks. This exercise program comprised 5–10 min of warming, 20–30 min of exercise, and 5 min of cool-down. Data were collected by the SF-36 questionnaire and analyzed by the SPSS version 18. Results: The results revealed that there was a significant difference in the mean score of various dimensions of quality of life including NYHA functional Classes II (P = 0.032) and III (P = 0.027), fatigue, BP, and general health in Classes II (P < 0.001) and III (P = 0.021) between the two groups before and after the intervention. Conclusion: Given that exercise leads to improvement of physical functioning, role-physical, role-emotional, social functioning, mental status, general health, and lower levels of fatigue and body pain in patients with congestive heart failure, it is recommended that patients incorporate regular exercise into their daily routines.
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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 2,931 306
* Source: CrossRef