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   Table of Contents - Current issue
September-December 2022
Volume 3 | Issue 3
Page Nos. 209-314

Online since Wednesday, December 28, 2022

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Telemedicine: A case of turning adversity into opportunity p. 209
Meenu Singh, Ketan Kumar
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Present status of department of health research registered ethics committees in india after implementation of new drugs and clinical trials rules 2019 p. 211
Neeraj Kumar Agrawal, Uma Gupta
Background: Under the New Drugs and Clinical Trials Rules -2019 that came into force on 14th September 2019, all Ethics Committees (ECs) reviewing biomedical and health research should register with the authority designated by the Central Government of India. Study Objective: We investigated the status of registration of ECs in the Department of Health Research (DHR) to date. Materials and Methods: The data collection was started on 1 April, 2021 and was last updated on 10 April, 2022. The ECs registered with DHR were extracted from NAITIK online portal. The ECs were segregated according to the state and Union territories, medical colleges, dental colleges, and hospital and research institutes. Results: Total of 836 registered ECs were uploaded on the DHR website to date. Out of which, 822 (98.32%) were Institutional and 14 (1.67%) were independent. Among total ECs, 518 (61.96%) were in hospitals and research institutes, 231 (27.63%) in medical colleges, and 73 (8.73%) in dental colleges. 76 (9.09%) got the final certificate after completion of a provisional period of two years. Among 606 medical colleges and 316 dental colleges, 38.11% and 23.10% of colleges had registered ECs respectively. Maharashtra has the highest number with 129 (15.43%) registered ECs whereas Gujarat is number one (53.33%) in terms of percent registered ECs in medical colleges of particular states. Conclusions: Timely registration of ECs should be encouraged by the concerned stakeholders and try to make a robust mechanism for bringing transparency, uniformity, and accountability to the ECs across the states.
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Clinico-Aetiological profile of children with fever and rash with special reference to dengue p. 219
Srishty Thakur, Rajesh Patil, Bharati Choubey, Jyotsana Shrivastava
Aim: Fever with rash is a common presentation in paediatric patients with a variety of differential diagnosis ranging from minor to life-threatening illnesses. Establishing an early diagnosis particularly of dengue infection, especially in a resource-limited setting is essential to reduce morbidity and mortality. The aim of this study is to evaluate the clinico-aetiological profile of children admitted with fever and rash and to find out different clinical and laboratory parameters for diagnosing dengue infection using screening tests. Methods: It is an observational cross-sectional study. All consecutive patients admitted to tertiary care centre during the study period (n = 120) between age group 1 month and 12 years were evaluated with detailed history and clinical examination and relevant investigations. For screening dengue infection, various clinical and laboratory parameters were used to find the best combination comprising the desired sensitivity, specificity, positive and negative predictive values (NPV) and likelihood ratio. Results: The most commonly affected age group was below 5 years. Among 120 patients, 64% had a laboratory-confirmed diagnosis out of which 45% patients were of viral aetiology, 10% patients had bacterial aetiology and 9% had non-infectious aetiology. Among viral infections, 18 patients were diagnosed as dengue immunoglobulin M enzyme-linked immunosorbent assay positive. Headache (100%), was the most common symptom followed by diarrhoea (83.3%), vomiting (83.3%) and altered sensorium (72.2%) in dengue-positive patients. All dengue patients had thrombocytopenia, 88.9% had leucopenia and liver function tests deranged in 77.8% of patients. The highest sensitivity and specificity values were found in the combination of fever, maculopapular rash, headache, absence of cough and thrombocytopenia (55.6% and 94.12%, respectively), followed by fever, maculopapular rash, headache, no cough, thrombocytopenia and leucopenia (with 50% sensitivity and 100% specificity). Both combinations also showed the highest values for positive and NPVs, positive likelihood ratio and maximum area under the curve using a receiver operating characteristic. Conclusion: Establishing the diagnosis of fever with rash in children can be challenging. A combination of parameters such as fever, maculopapular rash, headache, absence of cough, thrombocytopenia and leucopenia can be used as a screening tool for early diagnosis of dengue infection in a resource-limited setting.
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An appraisal of knowledge, attitude and practices of anganwadi workers under integrated child development services scheme on infection prevention and control in the initial months of COVID-19 pandemic in District Lucknow, UP, India p. 224
Manish Kumar Singh, Mukesh Maurya, Ahmed Shammas Yoosuf, Shikha Nargotra, Priyanka J Pawar, Ritika Mukherjee, Archisman Mahapatro
Background: During the COVID-19 pandemic, Anganwadi workers (AWWs) were repositioned for community support, community surveillance, community awareness on infection prevention and mitigating stigma/discrimination entailing infection, going door to door. The job entailed good knowledge, attitude and practices (KAP) with regard to infection prevention and control (IPC). Aims: To assess the KAP of AWW with regard to IPC in context of COVID-19 in Lucknow district. Methods: A cross-sectional survey was conducted using Google form between 30 June and 28 July 2020. AWWs were recruited from Lucknow district irrespective of their training status; data analysis was done on 137 participants. The mean KAP score was calculated and student t-test was applied. Chi-square test was performed between categorical variables and KAP. Univariate and multivariate logistic regression was applied between independent and dependent variables. Results: The mean score of knowledge was 7.22 ± 2.64, attitude was 4.34 ± 1.14 and practice was 4.44 ± 1.11. There was a significant difference between good and poor score for KAP. Participants with older age, good knowledge and attitude scores were more likely to have good practices. Conclusion: AWWs had good attitude and practices, but lacked adequate knowledge on IPC measures. Ensuring training for AWW on IPC is important.
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Prevalence of iodine deficiency and urinary iodine excretion among school-going children in a Southern District of Karnataka – A cross-sectional study p. 231
Ramachandra Kamath, Rajashree Kotabal, K Kruthika, Sharvanan E Udayar, Jagadish Gangani
Background: Iodine deficiency is a major public health problem, which leads to impaired neurodevelopment, particularly in early life and is the single most preventable cause of mental retardation and brain damage in children and fortunately, it is preventable. Aims: To estimate the prevalence of goitre among school children in Kodagu District and to estimate the urine iodine excretion and salt iodine content in a subsample. Patients and Methods: A cross-sectional study was conducted among school children of 6-12 years in the Kodagu district. Sampling was done by population proportionate to size cluster sampling method with 2700 study participants, 540 salt samples and 270 urine samples. Results: Out of 2700 study participants, the prevalence of goitre was 15.50%. Students of Madikeri Taluk, rural area students, 11-year-old students, Consumption of Goitrogens among students show significant association with goitre after multivariate logistic regression analysis. Urinary iodine excretion test shows 0.36%, 1.80% and 12.99% of the participants had severe, moderate and mild iodine deficiency, respectively. Conclusion: The prevalence of goitre was high indicating that it is an endemic area. Activities such as periodic surveys, provision of iodised salt and intensified monitoring and further evaluation of the IDD programme is obligatory to reduce the goitre rate.
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Predictive Value of Beclin1 in the Pathogenesis of Rheumatoid Arthritis in the Indian Population p. 238
Tanu Varshney, Praveen Kumar Singh, Sarama Saha, Sukdev Manna, Venkatesh S Pai, Manisha Naithani, Anissa Atif Mirza
Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease leading to the destruction of articular cartilage and deformity of joints if not detected early. There is an unmet need to find out a highly sensitive and specific biomarker for RA. This was the first study designed in Indian setting to assess whether it can be used as a biomarker in the diagnosis of RA in the Indian population. Aim: To correlate serum Beclin1 in the pathogenesis of rheumatoid arthritis in the Indian population. Patients and Methods: Observational analytical study was conducted for 18 months at AIIMS Rishikesh, Department of Biochemistry in collaboration with the Department of Rheumatology. Beclin1 serum expression levels were estimated by the enzyme-linked immunosorbent assay and beclin1 mRNA expression was assessed by a real-time polymerase chain reaction from peripheral blood mononuclear cells (PBMCs). Beclin1 expression was compared by Mann–Whitney U-test using SPSS 22 version. Cut-off values of Beclin1 for screening of cases were analysed by receiver operating characteristic test. Results: Age- and sex-matched 38 RA patients (5 males and 33 females) and 39 controls (8 males and 31 females) were recruited in the study. Patients with the American College of Rheumatology/European League Against Rheumatism score ≥6 were recruited in this study. Serum level of beclin1 was significantly (P ≤ 0.001) lower in cases (6.30 [2.82]) compared to healthy controls (11.43 [4.62]) which were corroborated with mRNA expression. The optimal cut-off value for detecting RA cases was 7.25 with 89.7% sensitivity and 79.8% specificity. Conclusion: Beclin1 may be involved in the pathogenesis of RA and may be considered a diagnostic marker for RA cases.
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Patient-Generated health data: The high-tech high-touch approach: Where technology meets healthcare – A narrative review p. 242
Naseema Shafqat, Ranjana Verma, Surya Bali, T Jisa George
Patient-generated health data are a promising arena that can create a revolutionary change in the field of healthcare. Although a lot has been done globally to incorporate the information and data directly from the patient for their benefit, patient-generated health data (PGHD) remains a nascent area for the stakeholders including the clients themselves as well as the healthcare professionals and the system itself. This narrative review aims to familiarise the readers with the concept of PGHD, the strategies utilised by key organisations across the globe and to make them cognizant of the challenges and potential hurdles in the implementation and amalgamation of PGHD into the healthcare system. With the advancement in information technologies, artificial intelligence and remarkably evolving software, it has become easy to access health-related data such as heart rate, blood pressure, pulse oximetry and even electrocardiograms at the comfort of our homes with the touch of a button. The easy availability and affordability of smartphones for most of the population have led to the blooming of the wearable device industry, and there is a surge of primary health-related data overflowing around us everywhere. Proper utilisation of this deluge of data in the form of PGHD can reduce the healthcare cost and burden of care, especially in developing countries by improving the patient–provider interactions and bridging the existing information gaps. PGHD plays a significant role in health promotion also by supporting self-management activities such as healthy eating and exercise. In this modern era of precision health with comprehensive veracity, it becomes essential that researchers and healthcare professionals should lead from the front in the amalgamation of PGHD into healthcare.
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Stereotaxy in relation to world wars: A review on evolution of stereotactic frames p. 249
Jitender Chaturvedi, Prashant Raj Singh, Anil Kumar Sharma, Shiv K Mudgal, Suresh K Sharma
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Mucormycosis, COVID-19 Pandemic and the Lessons Learnt: A Review p. 256
Anila Varghese, Anita Upadhyay, Roy A Daniel, Twinkle Sharma, M Shyam Mohan, Balaji Susindran, Priyanka Singh, Chandrakant Lahariya
Mucormycosis emerged as a major public health challenge during the second wave of the COVID-19 pandemic in India in mid-2021. The disease, colloquially known as the Black fungus, was declared epidemic by the government. This review describes the epidemiological pattern and the determinants of mucormycosis. The review also proposes evidence based public health strategies for the prevention and control of mucormycosis. The rationale use of steroids in clinical management, formulation of evidence-based standard treatment guidelines and adherence to those guidelines by physicians, the strengthening of primary healthcare services to facilitate early care; compliance with infection prevention and control measures at all the health facilities; and early diagnosis and case management are the key strategies to prevent future emergence of mucormycosis. The article concludes that it is not enough that we tackle a health challenge at hand, in crisis mode. It is equally important that we derive learnings and take measures prevent any future. Effective control of mucormycosis and prevention of future outbreaks of disease is possible through coordinated actions of health policy makers, public health experts and clinicians. The entire episode is also a reminder for strengthening India's health systems at all levels – primary, secondary and tertiary – as well as in both public and private sector.
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Highlighting the role of nurses: A reflection on COVID-19 pandemic p. 262
Rajesh Kumar
The coronavirus pandemic brought new challenges and opportunities for health professionals, including nurses and nursing students. Nurses worked as front-line warriors to fight against COVID-19 worldwide. They worked round the clock to deliver the best possible care to critically ill patients admitted in critical care areas and use ventilators. Therefore, many national and international agencies, including the World Health Organization (WHO), the International Council of Nurses (ICN), and the United Nations (UN) body, have acknowledged the hard work of nurses during the pandemic. This document highlights nurses' diverse roles and responsibilities during the ongoing COVID-19 pandemic. Reflection on their work will further help policymakers support nursing professionals fighting against the virus and putting themselves at inevitable risk of coronavirus.
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Competency-based curriculum for anatomy in India: A critique p. 266
Tony George Jacob
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Defeating the deficits: Mask banks offer a promising solution p. 269
Tejal Mehta, Prateek Jain, Anushka Garg, Shriharmender Kant, Santosh Kumar, Ranjeeta Kumari, Ajeet Singh Bhadoria
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Ten years of impaction of a denture in oesophagus with acquired bronchoesophageal fistula p. 273
Rajesh Sharma, Brij Sharma, Deepika Bodh, Vishal Bodh
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Reconstruction with extracorporeal radiated bone in a primary malignant bone tumour, A doable option p. 276
Anil Regmi, Mohit Dhingra, Deepa Joseph
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Increase in the number of MBBS seats through the scheme of one medical college per district: The debate on quality versus quantity and opportunity to strengthen family physician system In India p. 280
Raman Kumar
India currently hosts the largest medical education system in the world with 650 medical colleges and 98613 MBBS (undergraduate) training seats. The reasons for Indian Medical Graduate's international migration and internal distribution within India have been multifactorial. There are push factors (with India) as well as pull factors (international host countries). Almost the same reasons are implied to the distribution and availability of the medical workforce geographically within India. To address the regional disparities in medical education and the availability of human resources in health, the policy of establishing one medical college in each district in India was initiated. Impressive progress has been achieved so far. However, the policymakers must look at it critically to be able to steer this project towards meeting the public health objectives of the country in the coming century. The discussion must include arguments on the type of doctor India needs. Indian can no longer afford the policy of having many cardiologists as compared to miniscule number of trained family physicians. All specialist system is being perused at the cost of a generalist health system. This paper critically looks at the district medical college scheme and exponential growth in the number of medical seats in India. Statistical success alone cannot address the public health needs and medical care of the Indian population. The creation of the National Medical Commission (NMC) has eased the criteria for recognition of new medical colleges; however, several limitations of the Medical Council of India are being carried forward within the functioning of NMC. Unless, there is a focus on creating employment and retaining medical graduates within the health system, it is worthless producing millions of them.
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Langerhans cell histiocytosis in a newborn p. 286
Mudita Arora, Arun Soni, Satish Saluja, Manoj Modi
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Percutaneous inferior vena caval filter placement p. 288
Sachin Madaan, Udit Chauhan, Pankaj Sharma
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Spirituality as an Effective Aid in Reducing the Mental Stress of Medical Students in India p. 292
Pulkit Johar, Harikrishnan Kodamana, Shubham Miglani
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Telemedicon 2022 Kerala 10th November to 12th November 2022 p. 294
Meenu Singh, Amit Agarwal
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The timing of a major operative intervention after a positive COVID-19 test affects post-operative mortality p. 297
Chander Mohan, Samiran Nundy
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A child with haemorrhagic bullous lesions: Atypical skin manifestation of henoch–Schonlein purpura p. 299
Bablu Kumar Gaur, Aafrin Bari, Divya Agrawal, Divya Raj Singh
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Clinical reasoning: How to achieve a greater clinical effectiveness in neurotrauma? p. 301
Md Moshiur Rahman, Luis Rafael Moscote-Salazar, Tariq Janjua, Amit Agrawal
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Revised BG prasad socioeconomic status scale for the year 2022: Updation based on latest base year series 2016 Highly accessed article p. 303
Nandita Sharma, Mahendra Singh, Yogesh Bahurupi, Pradeep Aggarwa
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Leslie H blumgart p. 305
Vinay K Kapoor
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A true visionary for the unsighted p. 307
Meenakshi Y Dhar, Anirudh Dhar, Puneet Dhar
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Aye zindagi – The show must go on! p. 312
Jaya Agarwal, Pallavi Kumar, Christi Titus Varghese, Unnikrishnan Gopalakrishnan, S Sudhindran, Urmila Anandh
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