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   Table of Contents - Current issue
January-June 2020
Volume 6 | Issue 1
Page Nos. 1-70

Online since Monday, July 20, 2020

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Learning curve from COVID-19 pandemic p. 1
Reba Kanungo
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Understanding the unusual viral outbreak: Coronavirus disease 2019 Highly accessed article p. 3
Tarun Kumar Suvvari, Lakshmi Venkata Simhachalam Kutikuppala, G Krishna Babu, Mamtha Jadhav
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the respiratory coronavirus disease 2019 (COVID-19). Coronaviruses are a large family of enveloped, positive-sense, single-stranded RNA viruses, which infect a broad range of vertebrate animals. The SARS-CoV-2 is spread primarily between people through close contact and through respiratory droplets produced from coughs or sneezes by the infected individuals. After entering into the human body, it enters human cells by binding to the angiotensin-converting enzyme 2 receptors, prominently present in lung, kidney, and gastrointestinal tract. Older people and people of all ages with severe chronic medical conditions such as diabetes, lung disease, and heart disease seem to be at higher risk of developing serious COVID-19 illness. There have been four pandemics caused by the emergence of new influenza viruses in the past century such as H1N1 Spanish flu (1918), H2N2 Asian flu (1957), the H3N2 Hong Kong flu (1968), and the H1N1 Swine flu (2009). Community interventions are important response strategies that can reduce the impact of disease. Widespread transmission of the virus could translate the situation into large numbers of people needing medical care at the same time. Better understanding of the complexity and dynamics of influenza pandemics reduces the further risk effect of such critical situations. Global efforts in tackling the virus at this time are focused all together on lessening the spread and impact of this virus.
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The ditans, a new class for acute migraine: Minireview p. 11
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
Lasmiditan (LDT), a new drug, was approved by the Food and Drug Administration in October 2019 for acute migraines with or without aura. LDT belongs to a new class of drugs “-ditans,” in which the mechanism is different from the triptans since it does not show vasoactive effects. The “-ditans” are more likely to be involved with the trigeminal system without causing vasoconstriction because of its low affinity for 5-HT1B receptors and highly selective 5-HT1F receptor agonist. The LDT probably decreases the neurogenic inflammation of the dura by lowering plasma protein extravasation and inhibits or suppresses neuronal firing in the trigeminal nucleus caudalis. Moreover, 5HT1F agonists have shown to decrease c-fos activity within the trigeminal nucleus, which reduces the level of synaptic activation. The onset of action of LDT is fast, which shows rapid absorption with good oral bioavailability. The peak plasma occurs within 2 h and the distribution is half associated with proteins. The LDT metabolism is hepatic but also nonhepatic by noncytochromes P450.
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Diabetic retinopathy awareness among patients with type 2 diabetes mellitus – A study from South India p. 15
Anulekha Mary John, Anju K Francis, Ancy George
Context: Awareness of diabetic retinopathy (DR), is necessary to prevent visual disability. Aim: The aim of the study is to assess the level of awareness of DR among patients with type 2 diabetes mellitus, presenting to a tertiary care center in South India. Settings and Design: This was a cross-sectional observational study conducted at the endocrinology outpatient department of a teaching institute in Kerala, India. Methods: Adult nonpregnant patients with type 2 diabetes who were given health education regarding diabetes and its complications were included in this study. A questionnaire was used to collect information. Statistical Analysis Used: Microsoft Excel 2007 was used to analyze the data and results were expressed as mean ± standard deviation and percentages. Results: Among 120 diabetic patients interviewed, 46 (38%) were aware that diabetes can affect eyes. Forty-two (35%) patients were well aware about DR. Thirty-eight (31.6%) patients reported that they did not consider an eye check-up necessary if they had no symptoms. Only 5% knew about dilated retinal examination. Among patients who were aware of retinopathy only 12 (28.5%) received the information from health-care providers. Only 47 (39%) participants had an eye examination in the previous year. Conclusions: Despite receiving appropriate diabetes education, patients' level of awareness and compliance to routine eye evaluation was suboptimal.
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Location and volume of intracerebral hemorrhage and their association with outcome p. 19
Venkateswara Rao Tangella, Nayyar Iqbal, Gopinath L Nayakar
Background: Intracerebral hemorrhage (ICH) accounts for around 10% to 20% of all stroke cases worldwide. It is one of the most fatal and disabling subtype of strokes. Volume of hemorrhage is well documented risk factor for mortality. Aims and Objectives: The objectives of this study is to find whether the location of ICH is an independent risk factor for morbidity and mortality. Material and Methods: It is a prospective cohort study involving adult patients with age more than 18 years presenting with ICH. All patients satisfying inclusion criteria were subjected to CT scan brain. The location of hemorrhages and volume were noted. The four independent variables – gender, presence of hypertension, location and volume of bleed were documented. Their association with modified Rankin scale was calculated using chi – square test, the significance was calculated with P < 0.05. Result: Eighty patients were recruited in the study. 72.5% were male and 27.5% were female. Mean age was 56.25 + 14.3 years. Hypertension was one of the commonest risk factor for ICH (80%). Volume of bleed more than 60 cc was associated with 100% mortality. The majority of the patients presented with ganglio – capsular hemorrhage (64%). Cerebellar and lobar hemorrhage had mortality of 66.7% and 100% respectively. The volume of bleed had odds ratio of 1.2 (P < 0.05). The logistic regression analysis adjusting location of bleed for volume was not significant (P = 0.47). Conclusion: Hypertension is one of the commonest risk factor for ICH. The volume of bleed is an independent predictor of mortality irrespective of location of hemorrhage, gender and other co-morbidity.
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Status of contact screening and isoniazid preventive therapy for children under age six in Puducherry district, under the Revised National Tuberculosis Control Programme: An operational research p. 24
Ariarathinam Newtonraj, Anil Jacob Purty, Mani Manikandan
Introduction: We assessed the contact screening of smear-positive pulmonary tuberculosis (PTB) and the coverage of isoniazid preventive therapy (IPT) in Puducherry district of Puducherry State. Methods: A retrospective record review of treatment cards, under the Revised National Tuberculosis Control Programme, was conducted between the reference period of October 2018 and December 2018. Results: A total of 145 index cases were linelisted. Among them, the number of household contacts of >6 years was 399, of which 359 (90%) were screened for PTB and one was diagnosed with PTB and initiated on treatment. Among the 35 children<6 years, 31 (89%) were screened and none was found to be positive for PTB. All patients were put on treatment (89%), of which 25 (71%) completed 6 months of IPT. Conclusions: Implementation of IPT in Puducherry district was satisfactory, and still, there is a hope to improve further. Nationwide data on contact screening and IPT implementation are required.
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Autologous serum skin test as an indicator of chronic urticaria in comparison with serum IgE level at a tertiary care center in North-Eastern India p. 28
Pranab Kumar Saha, Ravi Ranjan, Saurav Kundu, Deblina Bhunia, Pijush Kanti Datta
Introduction: Chronic urticaria (CU) is as a distressing condition that may present with short-lived itchy weal, angioedema, or both. Autologous serum skin test (ASST) is a simple in vivo clinical test for the detection of basophil histamine-releasing activity. ASST is a very simple, quick test which consists of intradermal injection of patient's own serum into the volar aspect of forearm. A significant association between increased total IgE and CU severity was found. The present study was done to find out the clinical profiles of CU in MGM Medical College and LSK Hospital. ASST was done, and serum IgE level in patients with chronic spontaneous urticaria estimated and to give an insight on degree of serum IgE level with ASST positivity. Materials and Methods: This was a cross-sectional study where a total of 100 patients were enrolled. Detailed history, physical examination, and routine investigations were recorded for all patients. ASST and serum IgE were done in all patients. Results: Of total of 100 patients enrolled in the study, ASST positive group consists of 29 patients and ASST negative group consists of 71 patients. A total of 46 patients got raised IgE, and the rest 54 had normal IgE level; out of IgE positive, 34 patients were ASST negative, and rest 12 patients were ASST positive. Majority of ASST positive patients had normal serum IgE level (n = 17). Nine and three patient's IgE level were in the range of 200–300 and 300–400 IU/ml, respectively. Conclusion: The ASST is a simple, practicable in vivo intradermal test for the detection of autoimmune urticaria. There was significant association seen with the duration of disease and ASST positivity. The present study did not show any association between increased serum IgE and ASST positivity.
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A clinical study of risk factors associated with amputation in diabetic foot disease patients attending a tertiary care hospital in a rural setting p. 34
Taraka Krishna Nulukurthi, Sistla Raj Kumar, Lakshmi Venkata Simhachalam Kutikuppala
Background: Diabetes mellitus is a disease of complications, which is rapidly increasing in prevalence worldwide. The total population affected by diabetes is projected to rise from 171 million in 2000 to 366 million by 2030. Approximately 20% of all diabetics who visit the hospital are admitted for foot problems. Diabetic foot ulcers and amputations continue to cause considerable morbidity among persons with diabetes throughout the world. Amputations are considered as a very debilitating complication of diabetes. Vast majority of diabetic foot complications resulting in amputation begin with formation of skin ulcers. Objectives: The main objective of this study is to examine various risk factors to predict lower extremity amputation in diabetic patients and to understand various measures which will reduce the level of amputation. Subjects and Methods: Fifty diabetic patients with foot lesion admitted in our hospital from September 2016 to August 2018 were studied by taking detailed history and thorough clinical examination. Grading of the foot lesions was done by Wagner's staging. Results: The incidence of foot lesion was higher in 51–60 years' age group in males and females. Majority of the patients (38, 76%) had a history of trauma as a predisposing factor to diabetic foot. Out of 20 patients walking barefoot, 12 people (60%) had amputations. Conclusions: It is concluded that rural origin of the patients was found to be another predisposing factor for the development of diabetic foot. This is due to the illiteracy of the patients regarding diabetes and its complications, unavailability of proper health-care facilities, and late presentation to the hospital.
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Analysis of blood and blood components wastage in a tertiary care hospital in South India p. 39
Kingsley Simon, Marie Moses Ambroise, Anita Ramdas
Objectives: The aim of the study is to determine the rate and reasons for blood and blood components wastage in the blood bank of a tertiary care hospital. Background: A major challenge facing the blood bank is to supply a sufficient amount of safe blood whenever required. India fell short of 1.9 million units of blood in 2016–2017. To overcome the shortage of blood supply, performance of blood bank can be increased either by increasing the level of resources from voluntary donors and/or by reducing the wastage of blood and blood components. Materials and Methods: This is a retrospective analysis of discarded blood components data in Pondicherry Institute of Medical Sciences from January 1, 2014, to December 31, 2018. The study analyzed the various factors responsible for discarding of whole blood, red cells, platelets, fresh frozen plasma (FFP), and cryoprecipitate units. Wastage rate was calculated with a percentage of total number wastage against the total number of collection. Results: A total of 36,631 blood components were prepared from 12,615 whole blood donations during this study period. Of the total, 7,103 (19.3%) components were discarded. The most common blood component discarded were platelets 5,980 (84%) followed by FFP 669 (9.4%) and packed red cells 451 (6.3%). Blood component expiry was the common reason for discarding. Conclusion: Implementation of proper blood transfusion policy, donor screening, and training of technical staff will help to reduce the discard rate and solve the shortage of these precious elements.
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Cytomorphology of lymphadenopathy with a report on patterns of tuberculous lymphadenitis in a resource-limited setting p. 45
Bakiarathana Anand, Anand Mariaselvam
Context: Lymphadenopathy is one of most common clinical presentations, for which fine-needle aspiration (FNA) is indicated as the first-line investigation since it is a reliable, rapid, simple, cost-effective procedure done in the outpatient department. Aims: The study was performed to assess the various cytomorphological patterns of the lymph node aspirates in patients presenting with peripheral lymphadenopathy. Subjects and Methods: The prospective study included 81 patients with complaints of peripheral lymphadenopathy on whom FNA was done in the Department of Pathology at our hospital. The smears were analyzed and categorized according to their cytomorphological patterns. Results: Of 81 patients, 30 were male and 51 were female. The male:female ratio was 1:1.7. The age of the patients ranged from 3 to 83 years, with a mean age of 35.2 years. Reactive lymphadenitis (48.15%) was the most common lesion followed by tuberculous lymphadenitis (33.33%). Acid–fast bacilli (AFB) positivity was noted in 13 out of 27 cases (48.15%) with tuberculous lymphadenitis. The cases of tuberculous lymphadenitis were further divided into three groups based on cytomorphology, of which Group 2 lesions (epithelioid granulomas with necrosis) were most common and Group 1 lesions (epithelioid granulomas without necrosis) were least reported. Group 3 lesions (necrosis without epithelioid granulomas) were all positive for AFB. There were nine cases (11.11%) of acute suppurative lymphadenitis and six cases (7.41%) of metastatic squamous cell carcinoma to the lymph nodes. Conclusions: FNA is an ideal tool which can be used as a basic investigation for the evaluation of lymphadenopathy. Reactive lymphadenitis followed by tuberculosis was the major cause of lymph node enlargement in our setup. Epithelioid granulomas with or without necrosis and/or AFB positivity on the cytological smears and with associated clinical symptoms should be considered as tuberculosis in our clinical setup unless proven otherwise.
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The effect of recurrent malaria infections on bone and cartilage at the distal femoral epiphysis of rats: A histological study p. 51
Ato Ampomah Brown, Nkechi Oluwakemi Dike, Leonard Derkyi-Kwarteng, Chrissie Stansie Abaidoo
Objective: The aim of this study was to investigate the normal changes that occur at the distal femoral epiphysis of rats and determine whether recurrent bouts of malaria altered them in anyway. Materials and Methods: The 1st phase of the study made use of 30 Sprague-Dawley rats aged 4 weeks. Two rats were culled each week for 15 weeks, the femoral bones of the rats were then harvested. Histological sections of the distal femora were prepared and studied. The 2nd phase involved 32 animals that were randomly assigned to four groups of 8 animals each. (Group A to D) Group A was given oral antimalarial drugs only, Group B was inoculated with Plasmodium berghei (NK65) only, Group C was inoculated with P. berghei (NK65) and treated with oral antimalarial drug, and Group D animals were neither inoculated nor given antimalarial drugs. At the end of the experiment histological sections of the femoral epiphysis of the rats were prepared and studied. Results: The microscopic architecture of the epiphyseal cartilage changed significantly as the animals aged. Significant differences were observed in mean bone thickness of the various experimental groups. There was however no significant difference in the mean cartilage thickness when comparison was made within the various groups. Conclusion: Although recurrent bouts of malaria infection appear not to alter the normal histological changes that occur in epiphyseal bone and cartilage layers, it most likely has an adverse effect on the rate of bone tissue deposition.
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An unusual case of steatorrhea p. 57
C Bharath Kumar, Betty Simon, Ebby George Simon
Partial agenesis of the pancreas is a rare developmental anomaly of the pancreas which can lead to exocrine and endocrine insufficiency. We report a 61-year-old male patient with steatorrhea who was found to have complete agenesis of the dorsal pancreas. He presented with a history of loose stools for 5 years, and the stools were at times oily in nature without mucus or blood. His clinical examination was unremarkable. Seventy-two hour stool fat was increased (21.4 g, normal<18 g) and stool elastase was low (120 μg, normal >200), and computed tomography of the abdomen revealed a normal head and uncinate process of the pancreas, abscence of body and tail of pancreas associated with a nondilated duct system. He was put on pancreatic enzyme supplements and he responded to the treatment, and on follow-up after 6 months, his stool frequency had declined and his fecal elastase had improved.
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Intraoperative water intoxication and hypothermia in a patient undergoing hysteroscopic submucosal fibroid resection p. 60
Nagalakshmi Palanisamy, Mamie Zachariah, Nikitha Mani
Hysteroscopy is a useful diagnostic tool as well as a treatment option in many of the gynecological procedures. Although hysteroscopic procedures are generally safe in expert hands, the clinicians can face complications during and after the procedure. One of the intraoperative complications is water intoxication during the procedure. The pathophysiology and treatment of this complication are similar to the TURP syndrome. Hypothermia due to the absorption of cold irrigation fluid is another complication we must be aware of. Vigilant monitoring and choice of regional anesthesia can help early detection and prevention of these complications.
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Coronavirus disease 2019 pandemic: Upscaling the preparedness and public health emergency response at the point of entry p. 63
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
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Prospects in Immunomodulatory activity of Amphotericin B in viral infection: Promising developing therapeutic branch p. 65
Falah Hasan Obayes AL-Khikani, Aalae Salman Ayit
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Candida auris candidemia – An emerging threat: A case report and mini-review of the literature p. 68
Mahmood Dhahir Al-Mendalawi
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Implementing programmatic assessment across medical colleges in India p. 69
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
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