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   Table of Contents - Current issue
Coverpage
January-June 2021
Volume 7 | Issue 1
Page Nos. 1-52

Online since Friday, July 2, 2021

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EDITORIAL  

Mucormycosis: New actor in the saga of COVID-19 Highly accessed article p. 1
Reba Kanungo
DOI:10.4103/2455-3069.320511  
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ORIGINAL ARTICLES Top

Evaluation of ocular manifestations of patients with pathological myopia at a tertiary eye care institute in Western India p. 3
Kinjal Trivedi, Charmi Madhani, Aditi Kondapurkar, Somesh Aggarwal
DOI:10.4103/jcrsm.jcrsm_60_20  
Introduction: Pathological myopia (PM) is defined as a refractive error ≥(−6) D or an axial length >26 mm causing complications such as early nuclear sclerosis, zonular dehiscence, macular hole, lacquer cracks, Forster-Fuchs spots, myopic traction maculopathy, macular choroidal neovascularization, and peripheral degenerations predisposing to rhegmatogenous retinal detachment (RRD). Materials and Methodology: In this cross-sectional observational study, we have studied 106 eyes of 56 patients. After history and examination, axial length was measured using A-scan biometry. Patients having myopic maculopathy underwent optical coherence tomography and fundus fluorescein angiography and were treated appropriately. The data were entered into Microsoft Excel sheet for statistical analysis. Results: Incidence of high myopia was maximum in 21–30 years (36%). Eighteen percent had positive family history, and in 89%, the presentation was bilateral. About 43.39% eyes had refraction value in the range of −6 to −10 D and 70.75% eyes had axial length between 26 and 30 mm. Nearly 39.62% eyes had best-corrected visual acuity in the range of 6/18–6/36. Fifty-two percent eyes had some vitreous degeneration. Myopic choroidal neovascular membrane (CNVM) was seen in 4.71% eyes. Lattice degeneration was the most common (43.39%) lesion predisposing to RD, majority seen in superotemporal quadrant (63.04%). Incidence of RRD was 6.52% and 15% in eyes with refractive error less than and more than −10 D, respectively. Conclusion: PM can cause irreversible vision loss with its complications such as CNVM and RRD. Awareness among myopic population regarding visual hygiene, safety precautions, risks, and complications involved can detect complications at the earliest helping in retaining useful ocular function.
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A comparative study to see the outcome in patients suffering from fissure-in-ano following modified closed lateral internal sphincterotomy, closed lateral internal sphincterotomy, and fissurectomy p. 9
Sivaji Sankar Ghose, Mili Das Chowdhury, MY Dharmamer
DOI:10.4103/jcrsm.jcrsm_65_20  
Background: The present study was undertaken to evaluate the comparative results of “Modified Closed Lateral Internal Sphincterotomy (LIS), Closed LIS, and Fissurectomy” technique in treating fissure-in-ano in terms of relief of symptoms, healing of wound, postoperative hospital stay, recurrence rate, and postoperative complications. Materials and Methods: A total of 120 cases with definite history of fissure and clinically diagnosed cases of fissure-in-ano were selected for the study. A final diagnosis was made after proctoscopic examination under anesthesia during operation. The type of procedure which was to be undertaken was done by letting patient pick up slips randomly where the name of the procedure was written. Total 120 slips were made with 40 slips of each procedure written in them. Postoperative period was closely monitored, and all the cases were meticulously followed for a variable period of time. Results: In the present study, 68% of the patients were male and 32% were female. It was more prevalent in the age group of 18–40 years. Forty patients underwent modified closed LIS, 40 underwent closed LIS, and remaining 40 patients underwent fissurectomy. Postoperative pain, operative time, duration of hospital stay, and recurrence rate were compared. Conclusion: Fissure-in-ano is a very painful condition and may cripple the daily activity of the patient. Encouragingly, high success rates were achieved in our patients with the modified closed LIS technique.
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Nonalcoholic fatty liver disease in prediabetes – Predisposing and protective factors p. 14
Jennifer Miranda, Smitha Bhat
DOI:10.4103/jcrsm.jcrsm_64_20  
Introduction: Nonalcoholic fatty liver disease (NAFLD) is increasing worldwide with a prevalence ranging from 5% to 28% in India. It is a common cause of chronic liver disease and can lead to complications including cirrhosis and portal hypertension. NAFLD and insulin-resistant states such as obesity, type 2 diabetes, and prediabetes are interlinked. We studied the role of diet, dyslipidemia, and glycemia in the genesis of NAFLD in patients with prediabetes. Methods: This case–control study was done in 86 prediabetic subjects availing the services of a medical college hospital. Cases of NAFLD were diagnosed and categorized by severity by ultrasonogram. Symptoms, demographic profile, dietary history by 24 h recall method, anthropometry, liver function tests, lipid profile, and blood glucose were recorded. Results: Cases of NAFLD were found to have higher fat consumption and lower carbohydrate and protein in their diet. Fatigue and right hypochondriac pain were common symptoms among the cases, and their mean body mass index (27.2 kg/m2) was higher. When compared with prediabetic controls, cases of NAFLD had higher mean systolic and diastolic blood pressures, as well as impaired lipid profile and postprandial hyperglycemia. Conclusion: Obesity, dyslipidemia, and specific dietary patterns predispose patients with prediabetes to develop NAFLD. Additionally, postprandial hyperglycemia is associated with NAFLD. Thus, targeting postprandial hyperglycemia in patients with prediabetes may retard the development of NAFLD.
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Evaluation of quality assurance in the cytopathology laboratory of a tertiary care hospital in Eastern India p. 24
Debjani Mallick, Sayan Kundu, Sudipta Chakrabarti
DOI:10.4103/jcrsm.jcrsm_59_20  
Background: In this era of evidence-based medicine, clinical laboratories play a critical role in patient diagnosis and management. Aims: The present study aims to study the quality assurance in the cytopathology laboratory of a tertiary care hospital in the Eastern region of India. Materials and Methods: An observational, retrospective, and analytic study for 1 year was conducted. The sample size was 600. Simple random samples were selected including pleural fluids, ascitic fluids, cerebrospinal fluids, cervical cytology Pap smears, fine needle aspiration (FNA) cytology, and guided FNA samples. Results: Maintenance of authentication of reports and ISO accreditation showed no deficiency, whereas report generation, dispatch, and documentation of duplicate reports showed the highest deficiency (593, 98.8%) in maintaining quality assurance. Incomplete requisition was the most common cause of registration failure (3, 42.8%), whereas samples sent in wrong vials was the most common cause of sample collection failure (3, 37.5%). The presence of artifacts was the major factor affecting smearing technique (3, 50%). Lack of compliance to standardized protocol in manual staining and mechanical factors of automated strainers affected the staining quality (3, 37.5% each). Power cut and lack of adequate UPS backup affected the productivity of equipment mostly (3, 50%). Technical issues were the major factor affecting turnaround time (3, 50%). Lack of manpower at the report dispatch counter and logistics affected report generation and dispatch (2, 33.3% each). Randomly selected reports were crosschecked with histology and prediction accuracy measures were calculated. Conclusion: The preanalytical, analytical, and postanalytical factors have to be maintained adequately for ensuring quality assurance.
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Epidemiological characteristics of COVID-19-positive health-care personnel and their workplace contacts at a tertiary care hospital p. 29
Anjum B Fazili, Shamila Hamid Qadri, Uroosa Farooq Allaqband, Rohul jabeen Shah, Suhail Manzoor Shah, Javeed Ahmad Parray
DOI:10.4103/jcrsm.jcrsm_82_20  
Background: Health care personnel (HCP) are at risk for nosocomial acquisition of severe acute respiratory syndrome-COV 2 from the exposure to infected patients and co-workers. Aim and Objective: This study was done to assess the epidemiological characteristics of HCP with COVID-19 and their workplace contacts. Methodology: This is a cross-sectional study done from April to July 2020. Data were collected telephonically from the cases, whereas the data from contacts were collected by both face-to-face interview and telephonically. A total of 125 cases and their 552 workplace contacts were included in the study. Results: Majority of study participants were symptomatic, young males with majority reporting exposure within the health facility. Conclusion: Ensuring workplace safety and adequate availability of personal protective equipment and sanitizers are the responsibility which every HC facility has to take care of COVID-19, health-care.
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Health-seeking behavior of patients with diabetes mellitus: A community-based cross-sectional study in an urban area of Pondicherry p. 33
Balakrishnan Vaishnavi, Amit Kumar Mishra
DOI:10.4103/jcrsm.jcrsm_76_20  
Introduction: Health-seeking behavior is a complex outcome of many independent factors operating at individual, family, and community level. Studies have shown that there is an improvement in compliance to treatment and a decrease in the complications with an increase in patients' knowledge about the disease and its complications. The current study was done to explore the health-seeking behavior among patients diagnosed with diabetes mellitus (DM). Materials and Methods: A community-based cross-sectional descriptive study was conducted among patients diagnosed with DM in an urban area of Pondicherry. A simple random sampling method was used to recruit the study participants in the community. A predesigned structured questionnaire was used to collect information from the participants by conducting face-to-face interview. Data entry was done in EpiData and the analysis was done using the Statistical Package for the Social Sciences Version 21. Results: In the present study, 109 participants were included and interviewed. Majority of participants (29.4%) belonged to 61–70 years. Most of the respondents (56.8%) seek treatment from a private health facility. The most common comorbidity reported was hypertension (59.6%). Participants shared that unhealthy diet (55%), family history (25.7%), sedentary lifestyle (23.9%), and obesity (17.4%) were the risk factors of DM. Only 12.8% of participants were testing their blood glucose level at monthly intervals. Eight participants were on irregular medication, and among them, three participants told that they were irregular on treatment because their blood glucose levels were normal. Conclusion: The level of awareness on diabetes among the participants is not satisfactory though the overall treatment-seeking behavior is found to be satisfactory among the study participants. It is recommended to plan and implement various Information, Education and Communication (IEC) activities in the study area to increase the level awareness.
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Active tuberculosis cases in the community, lessons learned: Case series p. 39
R Mohankumar, GR Rajakarthika, NR Nandhinikumari, RN Sri, G Mruganayani, JM Julieanne, AS Shereen, Ariarathinam Newtonraj, Rajesh Kumar Konduru
DOI:10.4103/jcrsm.jcrsm_54_20  
India is working hard to eliminate tuberculosis (TB) by 2025 and one of the key strategy is active case finding (ACF) of TB by house to house visit in the community. Through this ACF, which was carried out in a rural area of Pondicherry, three active cases of TB were identified. Active cases found through ACF differs from passive cases finding mainly in health care-seeking behavior and act as a source for spreading of the disease in the community and it is imperative to discuss about them. All the three cases that were detected were having diabetes and two of them were from a scheduled community area. One among them is a “newly diagnosed” case, while the other two cases belonged to “loss to follow up” and “failure of treatment” criteria. There was a lack of motivation among these patients to seek health care and adherence to treatment; and the health system also needs to gear up to tackle these active cases in the community, so that elimination of TB can be achieved by 2025. All the cases were notified with the health system and appropriate intervention was started.
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CASE SERIES Top

Case series on the effectiveness of preoperative radiological templating on acetabular cup orientation in total hip arthroplasty of developmental dysplasia of the hip p. 42
Neetin P Mahajan, Ajay S Chandanwale, Sangeet K Gawhale, GS Prasanna Kumar, Lalkar Gadod
DOI:10.4103/jcrsm.jcrsm_70_20  
Total hip arthroplasty becomes the challenging treatment in cases of neglected developmental dysplasia of the hip but requires elaborate preoperative planning, especially for the restoration of the normal hip center, correction of shortening, and achieve normal biomechanics to avoid limb and early failures. To determine the morphological changes resulting from the dysplasia, the anatomic acetabular position, the height of the femur head dislocation and the combined anteversion must all be established. Preoperative planning was done using 100% zoom digital X-rays of the pelvis with both hips in 15° of internal rotation. This included identification of true acetabulum and centre of hip rotation using Ranawat's triangle. Templating was done to determine the position of acetabulum and size of the cup and required length of subtrochanteric osteotomy. The length of subtrochantric osteotomy was determined so that it would not lengthen the leg more than 3 cm to prevent sciatic nerve stretching. The postoperative X-rays were compared with the template of X-rays for the effectiveness of preoperative planning in restoring the near-normal biomechanics of the hip joint.
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LETTERS TO EDITOR Top

Vizag styrene gas tragedy: A public health view to prevent such incidents in future p. 49
Ariarathinam Newtonraj
DOI:10.4103/jcrsm.jcrsm_47_20  
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Evidence, end-points, and epistemic - Handling the uncertainty of COVID-19-related infodemic p. 51
M Shuriya Prabha, V Dinesh Kumar
DOI:10.4103/jcrsm.jcrsm_61_20  
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