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MGM Journal of Medical Sciences
Current Issue : Volume 4, Issue 2, April-June 2017
 
 
1.  From the Editors' Desk
From the Editors' Desk
Shibban K Kaul, Chander P Puri
[Pages No:iv]
Full Text PDF | Abstract | FREE

ABSTRACT

We are pleased to place second issue of the fourth volume of MGM Journal of Medical Sciences (MGMJMS) before our esteemed readers. The journal is in 4th year of its publication. Looking at the positive feedback of many of our readers in India and abroad, we feel that our efforts in nurturing the journal and putting it on the right track are bearing fruit. Right from the time of its inception, our sole aim and effort has been to keep maintaining the quality of the journal at a decent level and keep on improving it.

 
2.  ORIGINAL ARTICLE
Goitrous Hypothyroidism: Changing Clinical Profile
Alaka Deshpande, Abhijit Pancholi, Mayur Jain
[Pages No:55-59]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10036-1140 | FREE

ABSTRACT

Introduction: On availability of sensitive techniques and better understanding of pathogenesis, hypothyroidism is being detected in early stages in milder forms. The clinical picture is changing in the third millennium compared with what was described 50 years ago.

Materials and Methods: This is a comparative study of goitrous and nongoitrous cases referred for functional evaluation of the thyroid.

Results: One hundred and five cases of goitrous hypothyroidism are studied with hormonal and immunological parameters along with cytology; 80% of the cases were asymptomatic/had protean manifestations. The etiology was autoimmune thyroiditis as evident from raised levels of thyroperoxidase antibodies as well as histopathology.

Conclusion: Autoimmune thyroiditis is the commonest cause of goitrous hypothyroidism, i.e., being increasingly detected in the early stages with milder form. Clinicians need to be aware of the changing profile of goitrous hypothyroidism.

Keywords: Goitrous, Granulomatous thyroiditis, Hypothyroid, Thyromegaly.

How to cite this article: Deshpande A, Pancholis A, Jain M. Goitrous Hypothyroidism: Changing Clinical Profile. MGM J Med Sci 2017;4(2):55-59.

Source of support: Nil

Conflict of interest: None

 
3.  ORIGINAL ARTICLE
Morbidity Profile of People Living in the Vicinity of Mobile Towers, Jaipur City Rajasthan, India
Juhi Mittal, Amita Kashyap, Priyanka Kapoor, Monika Rathore
[Pages No:60-64]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10036-1141 | FREE

ABSTRACT

Introduction: In 2011, the International Agency for Research on Cancer classified mobile phone radiation as group 2B (possibly carcinogenic). Studies showed association with ailments like drying of the skin and fluid in the eyes, sleep disorder, lack of concentration/memory loss, tumors/cancers. Yet another study showed no significant association. According to data from the International Telecommunication Union, there are over 800 million mobile phone subscribers in India. The approximate estimate of cell towers in Jaipur city is 5,678. Hence, this study was done with the objective to find out morbidity profile of people living in the vicinity of mobile towers in Jaipur; secondary objective was to compare morbidity profile among people exposed to low vs high to moderate (HTM) level of mobile radiation.

Materials and methods: Observational cross-sectional analytical study was planned in four areas of Jaipur city having mobile tower for >10 years: Jawahar Nagar, Sanganer, Vidyadhar Nagar, and Vaishali Nagar. “Detex 189” was used to assess the radiation level, and SF-36 questionnaire was used to assess physical and mental morbidity.

Sample size: The sample size was 720 people, assuming 10% prevalence of radiation-related mental morbidity among people living in the vicinity of mobile tower, at 95% confidence interval with 2.5% absolute allowable error and keeping nonresponse as 25%, which will cover all morbidities.

Results and conclusion: Except for sleep disturbances (p-value = 0.002), there was no significant difference in presenting common health problems and diseases as per level of radiation. Status of physical functioning, bodily pain, vitality, mental health, overall physical component score, and mental component score was found to be significantly low among the people who are exposed to HTM level of radiation (with p-value = 0.000, <0.001, <0.001, < 0.001, 0.028, 0.002 respectively), but it did not limit their day-to-day work performance (p = 0.848), social functioning (0.420), and feeling of general health (p = 0.176). Since people in HTM radiation were significantly older (p = 0.002), these differences need further verification.

Keywords: Mobile tower, Morbidity, Radiation.

How to cite this article: Mittal J, Kashyap A, Kapoor P, Rathore M. Morbidity Profile of People Living in the Vicinity of Mobile Towers, Jaipur City, Rajasthan, India. MGM J Med Sci 2017;4(2):60-64.

Source of support: Nil

Conflict of interest: None

 
4.  ORIGINAL ARTICLE
Assessment of Medication Adherence in Type II Diabetic Patients: A Cross-sectional Study
Kishor Khotkar, Sameer Chaudhari, Pradeep R Jadhav, Yeshwant A Deshmukh
[Pages No:65-69]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10036-1142 | FREE

ABSTRACT

Introduction: Diabetes is a chronic disorder and requires longterm therapy. Lack of adherence to antidiabetic medication causes suboptimal glycemic control and can lead to treatment failures, development of complications, and increased mortality.

Aim: To study the medication adherence among type II diabetic patients at a tertiary care hospital in Navi Mumbai, Maharashtra, India.

Materials and methods: A cross-sectional, observational study was conducted for a period of 1 year in the Diabetology Clinic in a tertiary care hospital. A total of 100 type II diabetic patients, who were on antidiabetic drug therapy for at least 6 months, were enrolled. Blood glucose was measured and details of drug therapy were noted. Medication adherence was assessed using Morisky Medication Adherence Scale and adherence scores were calculated.

Results: Only 1% had high medication adherence, while 34% had moderate and 65% had low medication adherence. Medication adherence issues identified in type II diabetics were that they forgot to take/bring their medication when traveling, stoppage of medication once glycemic control is achieved, and difficulty in adhering to medication plan. Only 19% were having optimally controlled glycemic levels, whereas 81% were having uncontrolled glycemic levels. Medication adherence scores were lower (reflecting lower adherence) in type II patients with uncontrolled glycemic levels than those having optimally controlled glycemic levels, but this difference was not statistically significant.

Conclusion: Overall, the medication adherence was low in type II diabetic patients. The study shows that to improve medication adherence, better counseling and health education of patients are required.

Keywords: Medication adherence, Morisky Medication Adherence Scale, Type II diabetes.

How to cite this article: Khotkar K, Chaudhari S, Jadhav PR, Deshmukh YA. Assessment of Medication Adherence in Type II Diabetic Patients: A Cross-sectional Study. MGM J Med Sci 2017;4(2):65-69.

Source of support: MGMIHS

Conflict of interest: None

 
5.  ORIGINAL ARTICLE
Laparoscopic Ventral Hernia Repair: Our Experience in 75 Patients
Anshuman Pandey, Shakeel Masood, Smita Chauhan, Alankar K Gupta, Nitin Goel, Khalid Noman
[Pages No:70-74]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10036-1143 | FREE

ABSTRACT

Introduction and aim: Laparoscopic ventral hernia repair has become a method of choice for treatment of ventral hernias. It has benefits of shorter hospital stay, less pain, and better cosmetic results, although it continues to remain a challenging procedure, more so in reoperative abdomen and in patients with serious comorbidities. The aim of this study is to evaluate our experience of laparoscopic ventral hernia repair carried out by a single surgical team.

Materials and methods: Ventral hernia, both primary and incisional hernia, was repaired by laparoscopic intraperitoneal onlay mesh (IPOM) repair in 75 patients at a single center within 3 years between January 2013 and December 2016. This was done at a tertiary care center by a single operating team standardizing the procedure and evaluating the learning curve.

Results: Seventy-five patients underwent laparoscopic IPOM repair of which 45 were females and 30 males. The average age was 52 years (35-72) and size of defect ranged from 4 to 12 cm. Dual mesh with expanded polytetrafluoroethylene was used in all patients. Sixty-two cases were incisional hernias, 10 paraumbilical hernias, and 3 umbilical hernias. Of these, 14 were recurrent incisional hernias after open mesh hernioplasty out of which two cases recurred after laparoscopic IPOM. Mean operative time was 60 to 130 minutes. There were no conversions to open technique. The average hospital stay was 2 to 3 days. One patient had postoperative Richter’s hernia which was managed by relaparoscopic reduction and transfascial closure of the defect. Three patients had postoperative ileus, three developed minor wound infection, and one patient had seroma. The average follow-up period was around 12 months.

Conclusion: Laparoscopic IPOM ventral hernia repair is a safe procedure in most cases with benefits of rapid recovery and better patient outcomes, more so in large recurrent incisional hernias and in patients with serious comorbidities.

Keywords: Incisional hernia, Intraperitoneal onlay mesh, Ventral hernia.

How to cite this article: Pandey A, Masood S, Chauhan S, Gupta AK, Goel N, Noman K. Laparoscopic Ventral Hernia Repair: Our Experience in 75 Patients. MGM J Med Sci 2017;4(2):70-74.

Source of support: Nil

Conflict of interest: None

 
6.  ORIGINAL ARTICLE
Anorectal Surgeries under Local Anesthesia: A Single Center Experience
Harmandeep S Chahal, Kamakshi Garg, Abhishek Bose, Simran Kaur
[Pages No:75-78]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10036-1144 | FREE

ABSTRACT

Introduction: Surgeries done under local anesthesia are associated with fewer perioperative risks and postoperative complications compared to general or spinal anesthesia. This study was contemplated to test the feasibility and efficacy of local anesthesia in anorectal surgeries.

Materials and methods: This study was done in the Department of Surgery, Dayanand Medical College & Hospital, Ludhiana, Punjab, India. A total of 50 patients presenting with anorectal problems, aged more than 16 years and qualifying for grades I and II of American Society of Anesthesia classification, were selected for the study, after informed consent. A cocktail of bupivacaine hydrochloride 0.5%, lidocaine 2%, sodium bicarbonate and adrenaline, was injected around the perianal skin. Intraoperative parameters, such as blood pressure, pulse, respiratory rate, and intensity of pain were recorded in all the patients. Each patient was closely monitored postoperatively for timing and frequency of analgesic dose, need for bladder catheterization, immediate and delayed complications, time needed for patient to be ambulant and length of hospital stay.

Results: The duration of procedures was 19 ± 6 (mean ± standard deviation) minutes. Patients required analgesic dose after 4.25 ± 1.14 hours, with almost half (48%) requiring it after 6 hours. Majority of patients (82%) were ambulatory within the 1st hour with a meantime of 50 ± 13 minutes. Three cases had complicated postoperative course, with perianal infection and fissure formation.

Conclusion: Local anesthesia is effective and safe for anorectal surgeries, reducing recuperating time and allowing early ambulation. Such day care procedures, requiring lesser monitoring, can emerge as a preferred technique in low-resource settings, considering their cost-effectiveness.

Key words: Anorectal surgeries, Early ambulation, Local anesthesia, Perioperative complications.

How to cite this article: Chahal HS, Garg K, Bose A, Kaur S. Anorectal Surgeries under Local Anesthesia: A Single Center Experience. MGM J Med Sci 2017;4(2):75-78.

Source of support: Nil

Conflict of interest: None

 
7.  REVIEW ARTICLE
Role of Y Chromosome Microdeletions in the Clinical Evaluation of Infertile Males
Stacy Colaco, Aiman Lakdawala, Deepak Modi
[Pages No:79-88]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10036-1145 | FREE

ABSTRACT

Infertility is a multifaceted condition, which is on the rise in the last few decades. A stage of great importance in the development of human male gametes is spermatogenesis, which is governed by a set of genes located on the q arm of the Y chromosome. Loss of these genes can cause disruptions in spermatogenesis and, thus, lead to male infertility. Studies have identified several deletions on the long arm of the Y chromosome, called Yq microdeletions, which occur in three distinct loci termed AZFa, AZFb, and AZFc. In addition to these, there exist small subdeletions in the AZFc locus, called gr/gr, b1/b2, or b2/b3 subdeletions. Such deletions can lead to azoospermia or oligozoospermia by causing Sertoli cell-only syndrome, impairment in spermatogenesis, or maturation arrest. Testing for Y chromosome microdeletions is clinically significant for several reasons, since these deletions are exclusively associated with male infertility and their detection can help identify the cause of infertility. Knowing the presence or absence of Y chromosome microdeletion also aids in predicting the prognosis of oligozoospermic males, who are usually known to progress to azoospermia over time. The occurrence and type of Yq microdeletion are correlated with testicular phenotype in infertile males and, thus, serve as a good predictor of sperm retrieval. Vertical transmission of Y chromosome microdeletions from father to the male offspring is common in pregnancies achieved via assisted reproductive technologies; hence, the diagnosis of these deletions becomes imperative in such couples to prevent perpetuation of infertility in the next generation. Screening for Yq microdeletions is, thus, clinically significant and must be offered to all infertile males.

Keywords: Azoospermia, Male infertility, Microdeletions, Sperm count, Y chromosome.

How to cite this article: Colaco S, Lakdawala A, Modi D. Role of Y Chromosome Microdeletions in the Clinical Evaluation of Infertile Males. MGM J Med Sci 2017;4(2):79-88.

Source of support: Indian Council of Medical Research Postdoctoral Fellowship (14th batch)

Conflict of interest: None

 
8.  REVIEW ARTICLE
Photoplethysmography and Its Clinical Application
Ghanshyam D Jindal, Aparna S Lakhe, Jyoti V Jethe, Sadhana A Mandlik, Rajesh K Jain, Vinnet Sinha, Alaka Deshpande
[Pages No:89-96]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10036-1146 | FREE

ABSTRACT

Photoplethysmography (PPG), introduced in 1937, is routinely used for monitoring heart rate, blood perfusion and oxygen saturation of the blood in the intensive care units for the past several decades. It is also being used for the assessment of peripheral blood flow and venous filling time in noninvasive vascular laboratories. It works on the principle of light/infrared absorption in the body segment and detection and processing of transmitted light/infrared radiation.
In the past few decades, there has been more emphasis on the pulse morphology. Analysis of higher harmonic components and derivation of cardiovascular indices have emerged as powerful tools for the assessment of arterial aging, endothelial function, and vascular compliance. The ease of operating and extreme low cost of PPG system has made it ideal for objective assessment of autonomic nervous system (ANS). This technique is presently being explored for the personal monitoring of blood glucose noninvasively.

Keywords: Digital blood flow, Endothelial function, Heart rate variability, Photoplethysmography, Stiffness index, Venous filling time.

How to cite this article: Jindal GD, Lakhe AS, Jethe JV, Mandlik SA, Jain RK, Sinha V, Deshpande A. Photoplethysmography and Its Clinical Application. MGM J Med Sci 2017;4(2):89-96.

Source of support: Board of Research in Nuclear Sciences, Atomic Energy Department, Government of India, Bhabha Atomic Research Centre (BARC), Mumbai - 400085, India.

Conflict of interest: None

 
9.  CASE REPORT
A Case of Fournier's Gangrene of Penis leading to Complete Loss of Penile Urethra
Saket Sathe, Piyush Singhania, Nitin Joshi, Sanish Shringarpure, Nandkishor Raut, Niraj Tiwari
[Pages No:97-99]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10036-1147 | FREE

ABSTRACT

Fournier’s gangrene (FG) of penis is a rare but fulminant condition often associated with significant morbidity and mortality. Fournier’s gangrene typically spares testis, urethra, and deep penile components in view of their deeper blood supply, which is independent of compromised fascial and subcutaneous circulation. An unusual case of a 55-year-old nondiabetic male who presented to the emergency department of MGM Medical College, Navi Mumbai, India, with acute urinary retention due to impacted urethral calculus is reported. Patient developed FG of penis with isolated involvement of corpus spongiosum, leading to loss of penile urethra. Emergency penile exploration and debridement was done followed by elective perineal urethrostomy at a later date.

Keywords: Corpus spongiosum, Fournier’s gangrene of penis, Penile urethra.

How to cite this article: Sathe S, Singhania P, Joshi N, Shringarpure S, Raut N, Tiwari N. A Case of Fournier’s Gangrene of Penis leading to Complete Loss of Penile Urethra. MGM J Med Sci 2017;4(2):97-99.

Source of support: MGMIHS

Conflict of interest: None

 
10.  CASE REPORT
A Case of Postoperative Hypotension in a Patient of Sheehan's Syndrome
Shivali Tripathi, Siddharth Shah, Sushil Kumar
[Pages No:100-101]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10036-1148 | FREE

ABSTRACT

Sheehan’s syndrome is acute infarction and ischemic necrosis of the pituitary gland resulting from postpartum hemorrhage and hypovolumic hypotension. A 45-year-old female para 2 patient was admitted for total abdominal hysterectomy in view of pyometra. Patient was a known case of Sheehan’s syndrome with hypothyroidism. On day 2 of her surgery, she suddenly went into hypotension and tachycardia with electrocardiogram (ECG) finding of T-wave inversion. Biological marker for myocardial infarction namely creatine phosphokinase-MB was normal. The patient was started on hydrocortisone 100 mgintravenous injection thrice a day. Immediately, after the first dose of injection, she became normotensive and the pulse rate settled down. The ECG, taken 24 hours later, was normal.

Keywords: Postoperative hypotension, Postpartum hemorrhage, Sheehan’s syndrome.

How to cite this article: Tripathi S, Shah S, Kumar S. A Case of Postoperative Hypotension in a Patient of Sheehan’s Syndrome. MGM J Med Sci 2017;4(2):100-101.

Source of support: MGMIHS

Conflict of interest: None

 
11.  CASE REPORT
A Case of Progressive Supranuclear Palsy/Steele–Richardson–Olszewski Syndrome
Priyanka R Patgiri, Tushar K Biswas
[Pages No:102-104]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10036-1149 | FREE

ABSTRACT

Progressive supranuclear palsy (PSP) is an uncommon neurological disorder, the hallmark of which is supranuclear ophthalmoplegia involving vertical gaze. Other clinical features include pseudobulbar palsy (dysphagia and dysarthria), neck dystonia (retrocollis), bradykinesia, postural instability, and repeated falls occurring early in the course of the disease, personality changes, a staring unblinking facies, mild dementia, and cerebellar and corticospinal tract signs. Magnetic resonance imaging (MRI) of the brain on midsagittal images may reveal a characteristic atrophy of the midbrain in a shape that suggests a bird, particularly a humming bird. The PSP may resemble Parkinson’s disease (PD), but the pathophysiology is distinct from PD. Here, we report a rare case of a 72-year-old man who came with difficulty in naming objects and persons, dysphagia, dysarthria, difficulty in vertical gaze, and history of recurrent fall even while in sitting down position. He was diagnosed as PSP based on clinical examination and neuroimaging. The PSP has poor prognosis.

Keywords: Hummingbird sign, Mickey mouse ears sign, Progressive supranuclear palsy, Steele-Richardson-Olszewski syndrome.

How to cite this article: Patgiri PR, Biswas TK. A Case of Progressive Supranuclear Palsy/Steele-Richardson-Olszewski Syndrome. MGM J Med Sci 2017;4(2):102-104.

Source of support: MGMIHS

Conflict of interest: None

 
12.  CASE REPORT
Cervical–pharyngeal–brachial Variant of Guillain–Barré Syndrome: A Sequel of Leptospirosis
Fernaz Sherdiwala, Jeetendra Gavhane, Ishani Nathwani, Ankita Patel, Natesan Rewathi, Shekhar Patil
[Pages No:105-106]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10036-1150 | FREE

ABSTRACT

Guillain-Barré syndrome (GBS) is a lower motor neuron disease due to postinflammatory immunological reaction leading to demyelination. Usual preceding etiologies are acute viral episodes caused by cytomegalovirus, Epstein-Barr, and Zika infections, among others. Bacterial organisms causing GBS are Mycoplasma pneumonia, Campylobacter jejuni, Haemophilus influenzae, and Shigella. It can also occur postimmunization against rabies, influenza, MMR (measles, mumps, rubella) and conjugated meningococcal vaccine. A rare case of GBS (acute inflammatory demyelinating polyneuropathy) occurring after an episode of leptospirosis infection is presented.

Keywords: Cervical-pharyngeal-brachial variant of Guillain- Barré syndrome, Leptospirosis, Unusual presentation.

How to cite this article: Sherdiwala F, Gavhane J, Nathwani I, Patel A, Rewathi N, Patil S. Cervical-pharyngeal-brachial Variant of Guillain-Barré Syndrome: A Sequel of Leptospirosis. MGM J Med Sci 2017;4(2):105-106.

Source of support: MGMIHS

Conflict of interest: None

 
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