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   Table of Contents - Current issue
January-April 2022
Volume 3 | Issue 1
Page Nos. 1-115

Online since Thursday, April 28, 2022

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Social media and medicine: Time to embrace the digital age Highly accessed article p. 1
Mohammed Nadir Bhuiyan, Amit K Ghosh
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The need of the hour: Understanding the knowledge, attitudes, and practices of general public and at-risk groups in the COVID-19 pandemic management Highly accessed article p. 3
Hemant Kumar Singh, Pavithra Balakrishna, Ganne Chaitanya, Naresh Kumar Panneerselvam, Rajeev Aravindakshan, Pratyusha Ganne
Background: Understanding the public awareness, attitudes, and practices is needed to successfully control the COVID-19 pandemic. With the second wave of the pandemic spreading and reinstatement of lockdown in many countries, there is an urgent need to understand the knowledge, attitudes, and practices (KAP) of the people (especially the high-risk groups) to control mortality and morbidity. Aims: To explore the KAP of the general population of India and in particular, the at-risk groups, i.e., aged >55 years and those with comorbidities (diabetes, hypertension, chronic kidney disease, ischemic heart disease, and chronic obstructive pulmonary disease) who are at a high risk for developing severe COVID-19 infection and death. Patients and Methods: In this cross-sectional study, the questionnaires were administered through online survey links. The questionnaire had four sections, one for demographics and three each for KAP. The KAP scores were compared for a priori defined questions using Chi-square test, t-test, or ANOVA appropriately. Bonferroni corrected P < 0.05 was considered statistically significant. Results: Of the1259 responses, 83 (6.6%) were above 55 years and 193 (15.3%) had comorbidities. Higher education and income groups were more informed about COVID-19 disease (F > 18.5, P < 0.002). Participants in the at-risk groups had the same level of KAP scores as the general public. While a seemingly higher proportion of the at-risk group followed use-of-mask (n = 206, 94%) and 20 seconds of handwashing (n = 142, 65%), it was not significantly higher compared to the general population (P's > 0.4). Of the 1259 participants, 7%–10% of them did not practice social distancing at all times and 5%–7% were not wearing a mask at all times. Only 538 (42.7%) participants believed that this COVID-19 pandemic will be successfully controlled. Conclusions: This study highlights that at-risk groups are not better prepared compared to the general public, which is the need of the hour to prevent over-crowding of health systems and possibly mitigating COVID-19-related mortality.
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Comparative observational analysis of clinical outcomes in patients of vernal keratoconjunctivitis treated with eye drops olopatadine or bepotastine besilate Highly accessed article p. 9
Preeti Yadav, Ajai Agrawal, Puneet Dhamija, Anupam Singh, Sanjeev Kumar Mittal, Ramanuj Samanta
Objective: Observation and comparison of resolution of signs and relief of symptoms in patients of Vernal Keratoconjunctivitis (VKC) treated with 0.1% olopatadine eye drops or 1.5% bepotastine besilate eye drops. Materials and Methods: It was a prospective observational study of 60 patients of VKC from January 2018 to July 2019. Thirty confirmed cases of VKC were included in the study in each group. One group received 0.1% olopatadine eye drops and second group received 1.5% bepotastine besilate eye drops and were followed up for a period of 4 weeks. The main outcome measures were scoring and comparison of Total subjective symptom scores (TSSS) and Total objective sign scores (TOSS) within and between the groups at each follow up. Wilcoxon rank-sum test (Mann Whitney U test) was used to compare the two groups in terms of symptom and sign score at each of the time points. Friedman test was used to explore the change in score over time within each group. Generalized Estimating Equations method was used to explore the difference in change in score between the two groups over time. A p value of < 0.05 was considered statistically significant. Results: With treatment both TSSS and TOSS decreased consistently in both groups at the end of the two week and four week follow up time points. P Value of Comparison of the Two Groups in Terms of Difference of Subjective Score Total from Baseline to Follow-up Time points was statistically significant (P<0.001). Conclusion: At the end of the study, olopatadine 0.1 % eye drops was found to be more efficacious than 1.5% bepotastine besilate eye drops both for relief of symptoms and resolution of signs.
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Referral process in tuberculosis − Human immunodeficiency virus collaborative activities – Need for a relook into policy implementation in Uttarakhand p. 14
Ranjeeta Kumari, Bhola Nath, Vartika Saxena, Priyanka Semwal
Background: Provider-initiated testing and counselling (PITC), an essential component of tuberculosis (TB) human immunodeficiency virus (HIV) collaborative activities, is intended to translate into the increased rates of HIV testing in TB patients. Aim: The study intends to assess compliance with the referral process and other attributes of HIV testing in TB patients. Methods: The study was conducted at various designated microscopy centres (DMCs) in four randomly selected districts in the Garhwal region of Uttarakhand and included 346 patients. Results: Only 46.8% of patients went for HIV testing. The most common reason cited for not going was the absence of specific advice by the health staff at DMC. In addition, the long waiting time at Integrated Counselling and Testing Centres favoured the spread of infection to susceptibles in the waiting area. Binary logistic regression analysis also found that patient's importance towards HIV testing, advice by the health worker and higher education and age were significant predictors of HIV testing. Conclusions: The referral process at DMC requires closer monitoring and supervision for improvement in qualitative parameters. Training and supportive supervision of health staff at DMC for 'counselling' of patients during referral for testing are also necessary to preserve the essence of PITC.
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Stage migration in head-and-neck cancers due to extranodal extension: Clinical experience from a tertiary care centre p. 24
Deepa Joseph, Laxman Pandey, Rajesh Pasricha, Sagar Raut, Yanthan Yanpothung, Ajas Ibrahim, Manoj Gupta
Background: Extranodal extension (ENE) has been included as a factor for the staging of head-and-neck cancer (HNC) considering its prognostic value. Aim: The present study aimed to find out the percentage of patients with HNC getting upstaged because of ENE and their treatment outcome. Patients and Methods: A retrospective analysis of all patients with HNC registered in the Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India, between January 2018 and January 2019. American Joint Committee on Cancer (AJCC) criteria were used for defining clinical and radiological ENE. The site, subsite, stage and presence of ENE were documented. The clinical outcome of all these patients was collected and analysed. Results: A total of 562 patients were registered with HNC. Among them 45 patients were identified to have ENE (8%). The majority of the cases were oral cavity (44.4%) and oropharyngeal tumours (26.8%). Thirty-three patients had clinically documented ENE and 11 were radiological and one patient had pathological ENE. Among those who got upstaged to N3b disease due to ENE, 29 patients (64.4%) had N2 disease as per the 7th edition AJCC. When stage grouping was considered, 28 patients (62.2%) who got upstaged had stage Isovaleric acidaemia (IVA) disease as per the AJCC 7th Edition. Twelve patients were treated with radical intent and 16 received palliative treatment and rest did not complete the treatment or defaulted. Overall, the outcomes of these patients remained poor. Conclusion: A significant proportion of HNC patients got upstaged when ENE was included in the staging. Patients with ENE had a poor prognosis irrespective of the treatment modality.
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Role of systemic antibiotic prophylaxis and burn dressings in preventing invasive burn infections – A systematic review p. 28
Madhubari Vathulya, Akshay Kapoor, Debarati Chattopadhyay, Neeraj Rao
Background: Burn dressings and systemic antibiotics are used to combat invasive burn wound infections. With emergence of antibiotic resistance and a emergence of a large variety of dressings, it becomes important to work out a strategy to use systemic antibiotics and burn dressings effectively. Materials and Methods: A systematic database search to include PubMed/Medline, EMBASE, COCHRANE, SCOPUS was performed from January 2000 to January 2021 and reviewed to define invasive burn infection, and the topical antimicrobial therapy for clinical use. For the section on antimicrobials, MESH terms used were 'Antimicrobial Prophylaxis' AND 'burn Infection' and randomised controlled trial studies were alone selected. For the section on Burn dressings, another search was carried out with search words 'Dressings' AND 'Burn Infections'. Since the Search revealed several systematic reviews, the analysis was restricted to only those studies. Results: Systemic antibiotic prophylaxis does not seem to offer advantage in preventing burn wound infection, septic episodes or mortality. Although there is some benefit in decreasing mortality in patients of inhalation burn injury who would require mechanical ventilation. It can be given pre-operatively before skin grafting as there is improved graft survival in patients getting prophylaxis. Honey and hydrogel were found to promote wound healing while honey and skin substitutes prevented infection better than conventional dressings including silver sulphadiazine. For wound cover, though the permanent method of choice is still autologous skin grafts, with the advent of cell culture technologies, cultured autografts may hold a promising future. Conclusion: Systemic antibiotic prophylaxis can be given to patients of inhalational burn injury and as a pre-operative prophylaxis but not for preventing invasive burn wound infections. The ideals strategy for preventing invasive burn infection is isolation of the patient, wound cover (surgical/artificial) and frequent wound tissue sampling.
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Pilgrim health: Short sojourns to high altitude with pre-existing medical problems p. 42
Latika Mohan, Surinderpal P Singh, Jayanti Pant
Mountains have attracted travelers for short sojourns for pilgrimage, recreation or adventure which exposes them to the environmental stressors such as hypoxia, cold, low humidity and increased UV radiation. Such places are also often located in wilderness with poor access to medical aid and other resources. The present article aims to provide an overview for understanding the pathophysiology of common medical conditions in such extreme environments and the principles of their management.
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Presentation and severity of COVID-19 among cancer patients: A narrative review of existing evidence p. 49
Shanker Matta, Ram Bajpai, Rekha Shekhawat, Rajesh Kumar Singh
Coronavirus disease 2019 (COVID-19) continues to have a serious impact on people, including cancer patients and it was declared a public health emergency of international concern by the World Health Organisation. The present article attempts to review the prevalence, presentation and severity of COVID-19 among confirmed cancer patients from various studies. Cancer patients are vulnerable to COVID-19 and the data suggest that patients with cancer are at an increased risk of death compared to patients without cancer. Majority of patients from various studies presented with fever, cough or shortness of breath. Other symptoms included diarrhoea, nausea and vomiting, ageusia and anosmia. Those who died displayed higher rates of comorbidities compared with those who did not, including cardiovascular disease and hypertension. The risk of death was significantly associated with advancing patient age. Mortality from COVID-19 in cancer patients appears to be principally driven by age, gender and comorbidities.
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National nursing and midwifery commission bill: Hopes and challenges Highly accessed article p. 55
Rajini Peter, Suresh K Sharma
The purpose of this article is to summarise the major features of the National Nursing and Midwifery Commission (NNMC) Bill, as well as the opportunities and challenges that the proposed legislation presents. We look forward to improved professional standards, title protection, higher quality education, precise scope of practice guidelines and standardisation of nursing and midwifery registration as the Indian Nursing Council gets replaced by the National Nursing and Midwifery Council. We are hopeful for a rapid start and expansion of advanced nurse practitioner programmes, which will allow for increased participation in the country's health system and the advancement of health-care goals.
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National Education Policy 2020 compliant multidisciplinary education and research universities for dental education in India - A road map p. 60
Pradnya V Kakodkar, Shivasakthy Manivasakan
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Tracheoesophageal fistula masquerading as dysphagia and aspiration in traumatic tetraplegia p. 64
Osama Neyaz, Raj Kumar Yadav, Rahul Sharma, Pankaj Kandwal
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Sacral mass in a teenager - Scrimmage between neoplasia and infection: A case report with imaging appearances of mimics p. 67
Chandrika Sachar, Aakanksha Agarwal, Rahul Dev
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Collecting duct carcinoma of the kidney – A clinicopathological overview p. 71
Pakesh Baishya, Ravi Hari Phulware, Sanjeev Kishore, Ankur Mittal, Pankaj Sharma
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Using the social media to improve medical care p. 75
Patta Radhakrishna
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Radiological imaging in infiltrative hepatocellular carcinoma p. 78
Rosaiah Komirisetti, Tarvinder B S. Buxi, Mayank Goyal, Samarjit Singh Ghuman
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Technique of intrauterine foetal blood transfusion – A video article p. 80
Latika Chawla, Shalini Rajaram, Ankita Yadav, Daljit Kaur, Sweety Gupta, Jaya Chaturvedi
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Research: The perspective of medical undergraduates p. 82
Arpit Singh, Oshin Puri
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Meeting report: Fourth annual conference of the liver transplant society of India (LTSICON), 7th – 9th January 2022, Mumbai, India p. 84
Ravi Mohanka, Aabha Nagral, Prashantha S Rao, SK Mathur, Pravin Agrawal
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A 'One step' or 'Step-up' approach for infected pancreatic necrosis – Which is more suitable for a developing country? p. 88
Amitabh Yadav, Samiran Nundy
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SARS-CoV-2 associated to aneurysmal subarachnoid haemorrhage: Lessons learnt and recommendations from the pandemic p. 90
Daniuska Velasquez-Carralero, Tariq Janjua, Hefzi Andrea Montano-Bayona, Iván David Lozada-Martinez, Luis Rafael Moscote-Salazar
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NExT come, next served p. 92
Unnikrishnan K Menon
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The annihilation of caste prejudices p. 93
Harish Gupta
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The madam i knew p. 96
R Mangala
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Smith's recognizable patterns of human malformation, 8th edition p. 99
Prashant Kumar Verma
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Book review: How to practice academic medicine and publish from developing countries? p. 102
Sunilkumar K Pandya
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The spectrum of health hazards by a volcanic eruption and the need for an integrated approach to mental health and disaster preparedness p. 105
Shibu Sasidharan, Harpreet Singh Dhillon
Mt. Nyiragongo in Goma, DR Congo, exploded on 22 May 2022. In the Philippines, on 1 July 2021, the Taal volcano, considered a restive volcano, spewed a 0.62 mile-high plume of gas and steam into the air, cascading a mass evacuation. Without any prior warning, Goma and central Manila were in a state of emergency, not knowing what to expect and how to react. Volcanoes provide a conduit by which magma – the earth's molten rock, gases and water – may interact with human biological systems. The importance of effective pre-disaster planning cannot be over-emphasised in such situations. The article dwells on the volcanic phenomena, which can cause many health hazards during the eruption and in between eruptions. The vast majority of volcanogenic fatalities in the past few centuries have resulted from events at the proximity – such as pyroclastic density currents, lahars and suffocation or building/roof collapse from ash or debris – and also distal events, such as tsunamis, which may travel for hundreds of miles from the active site, and indirect consequences of eruptions, such as famine or infectious disease outbreaks, including podoconiosis, fluorosis, geophagy, iodine deficiency disorders and rift valley fever. Although technology and geology can give a better lead time, predicting natural hazards and formulating, a plan in advance will obviously be very helpful for public health professionals. This paper is intended for health-care workers to understand the health problems faced due to a volcanic eruption, and this understanding, along with the recommendations given, will enable them to plan and prepare for the management of relief, rescue and medical care.
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The cancer care messiah of Northeast India: Dr Ravi Kannan p. 111
Rajkumar Kottayasamy Seenivasagam, Puneet Dhar
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Theme: Experiments with print in Indian Contemporary Art p. 115
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