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   Table of Contents - Current issue
October-December 2020
Volume 7 | Issue 4
Page Nos. 163-233

Online since Wednesday, December 9, 2020

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The impact of COVID-19 pandemic on reproductive health care for women Highly accessed article p. 163
Sushil Kumar
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Utility of convalescent plasma for COVID-19 treatment p. 166
Prasanta Kumar Ghosh
The novel coronavirus identified and designated as SARS-CoV-2 has brought unprecedented suffering to people across the globe. There is yet neither an effective therapeutic substance nor a vaccine to treat the disease. Intensive research is being carried out globally to combat the menace. The road to success is miles away as effective drugs and vaccines (when available) are to be produced in adequate quantities and supplied at affordable prices to contain the disease. The observation that deployment of already-known technique of using convalescent plasma in the treatment of microbial diseases has yielded encouraging results in treating several deadly diseases, encourage the use of convalescent plasma collected from consented donors recently recovered from COVID-19 by plasmapheresis and using those for treating critically ill patients. The upgraded facilities for such purposes need to be in place along with the regulatory requirements for ensuring donor safety and judicious entitlement of convalescent plasma in patient care.
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Evaluation of e-learning of undergraduate medical students during the COVID-19 pandemic lockdown by an Objective Structured Practical Examination p. 176
Gurjeet Singh, Raksha Singh
Background: E-learning resources have a broad range of uses in medical education. Skills require the teaching of numerous domains, including cognitive and psychomotor domains in medical education. Feedback supports better competence in medical education, it has been shown that multimedia and e-learning tools have improved testing in both cognitive and psychomotor domains. Aims and Objectives: This study was conducted to evaluate the e-learning of undergraduate medical students with an Objective Structured Practical Examination (OSPE). Materials and Methods: A total of 96 of 150 medical students participated in a single group in e-learning, as this study was purely Internet based, so it may be that the remaining 54 students did not participate due to no Internet connectivity. By using OSPE, we have created two stations (video based), one was hand hygiene and the second was biomedical waste management. At the start of 30min, students were sensitized to lectures (one-way teaching) followed by a 30-min video of each station using the GoToMeeting app. In the end, the students were asked to correct steps of hand hygiene and segregation of biomedical waste, according to the color-coding system. Results: Of 96 students who took both the tests and gave their feedback on the questionnaire, 95.83% felt that they were given adequate time at each station, 68.75% responded that the teaching material provided in the e-learning resources were clear and easy to understand, 73.96% responded that the e-learning resources covered a wider range of knowledge than the traditional examination, 86.46% said that the e-learning resources were helpful in understanding basic hand hygiene concepts, 94.79% said that the e-learning resources were helpful in memorization and revision of hand hygiene practical skills, 61.46% opined that e-learning resources were easier to pass than traditional examination, 96.88% responded that the OSPE assessment of the e-learning process helped in scoring better than the traditional assessment methods and was less stressful, 81.25% said that OSPE helps in e-learning as well as evaluation in competency-based medical education (CBME), and 96.88% said that OSPE should be implemented in medical education as an assessment tool for both formative and summative evaluation. Conclusion: e-Learning advances can possibly substitute face-to-face address in medical education, especially during this pandemic. Such methodologies may not exclusively be vital for successfully handling the clinical training quandary during this present emergency; however, it will likewise serve to establish the framework for educating during future calamities and past.
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Is migration stress related to increased cardiovascular diseases? p. 184
Shridhar Dwivedi, Ramesh Aggarwal, Nisha Vohra
Introduction: Mass migration during the war, frenzy riots, famine, or due to compelling economic reasons are known to be associated with different health issues besides human distress and suffering. India has witnessed such a mass migration immediately before/during the independence (August 15, 1947) consequent to partition riots occurring in west and East Pakistan (present Bangladesh). Although many publications are there about the human and social tragedies associated with partition not much is known about the long-term cardiovascular related diseases of partition migrant individuals. The current communication is trying to address whether cardiovascular diseases in post-partition migrant subjects are any different from non-migrant individuals. Objectives: To evaluate cardiovascular morbidity pattern among partition migrants and non-migrant people. Materials and Methods: This is an observational study done at a tertiary care center from January 2016 to June 2019. The study population had migrant ethnic Indians (n = 30) from West Pakistan and non-migrant ethnic Indians based in Delhi (n = 30). Patients were asked about their demographic details, birthplace particularly the pre-independence place of birth/residence, a detailed pedigree analysis and cardiovascular risk was assessed. Statistical analysis was done to compare the proportion between the migrants and non-migrants subjects using Chi-square/Fisher’s exact test. Results: The mean age of migrants and non-migrants was found to be 78.46 ± 7.13 years and 78.16 ± 6.10 years respectively. Males (65%) were found to be more in both groups compared to females (35%). Both the migrants (83.33%) and non-migrants (73.33 %) were mostly from socioeconomic status (SES) I and II. Migrants (16.66%) showed more smoking habits compared to non-migrants (10%). Migrants were mostly suffering from hypertension alone (20%) or with two comorbidities (63.2%) like hypertension and diabetes, hypertension and coronary artery disease (CAD), diabetes and CAD, cardiovascular diseases (CVD) with stroke. In non-migrant patients hypertension alone was seen in 16.6% of cases which is not statistically significant. Two comorbid cardiovascular conditions in this group were seen in 36.8% of cases as compared to migrant population with two comorbid conditions and this difference was statistically significant (P = 0.039).
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COVID-19 strikes: An assessment on psychological vulnerability among quarantined subjects in hospital of city of Kolkata, India p. 189
Tanmoy Mitra, Kedar R Banerjee, Suman Nandi
Introduction: Pandemic of coronavirus disease-2019 (COVID-19) appeared as the most precarious yet unforeseen threat to the existence of mankind. From China it has spread throughout the world and till today the number of infected and death tolls reported are appalling and terrifying. Apart from physical health, the mental well-being of those who are exposed to possible infection is seriously at stake. Aim: This study was an investigation of the mental health status of quarantined subjects in Kolkata Hospital. It aimed to assess how the psychological constructs of quarantined subjects may play a role in psychogenic vulnerability and risk adjustments at the outbreak of this pandemic. Materials and Methods: A total of 60 quarantined subjects in the hospital were assessed for the internal and external locus of control, high and low resilience, upper and lower anxiety symptoms, and high low trait anxiety. The above eight groups were investigated on 18 emotional and dispositional factors on a Likert scale. Results: Significant intragroup differences observed between locus of control and resilience groups in regard to most dispositional and emotional elements. Anxiety symptoms and trait anxiety groups reflected no such intragroup significant differences. Comparisons between the high resilience group and high anxiety group displayed significant differences in most emotional and dispositional measures. Conclusion: Internal locus subjects appeared to be anxious and particular about health and ready to comply with new imposition of health rule. The low resilience group reacted negatively to the most dispositional and emotional measures when compared to the higher resilience group. The high trait anxiety group and high anxiety symptoms group reflected mostly similar responses. All groups acknowledged the health workers’ roles and recognized the need for medical spending for pandemics. Clinical Significance: This study indicates that quarantined subjects with high resilience can fare better facing a psychological crisis as the pandemic of COVID-19.
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Arterial desaturation during upper gastrointestinal endoscopy in nonsedated patients p. 198
Ashis K Saha
Introduction: Upper gastrointestinal endoscopy is the first and basic diagnostic procedure to diagnose mucosal disease of the esophagus, stomach, and duodenum, but arterial desaturation is a common occurrence during insertion of the scope and this can be detected by using pulse oximeter attaching with the finger during the procedure. Materials and Methods: In this prospective cross-sectional study done in MGM Medical College and LSK Hospital, Kishanganj, Bihar, India, 1814 patients underwent this procedure for diagnosis only in nonsedated condition only by oral anesthesia by xylocaine spray and pulse oximeter probe in the finger to monitor arterial oxygen saturation, pulse, and automated blood pressure monitor blood pressure. All the variables were measured before the procedure, at the insertion of the scope, during the procedure, and after the extubation of the scope. Results: Among 1814 patients aged under 50 years were 1137 (females = 494 and males = 643) and above 50 years were 677 (females = 307 and males = 370) with average hemoglobin of 11.9 gm%. During the insertion of the endoscope, there was sudden dipping of oxygen saturation in both the age groups more significantly in the case of the above 50 years of age group (P < 0.05) as compared to others. Systolic blood pressure also increased significantly during insertion (P > 0.05) in both the age groups as compared to baseline. But the pulse rate did not significantly increase as compared to the baseline rate prior to insertion in both groups. With the progress of endoscopy oxygen saturation both blood pressure came to normal but the pulse rate increased as compared to baseline. Conclusion: Common complication, arterial desaturation during endoscopy procedure can be recognized by pulse oximetry in nonsedated patient and this will prevent serious consequences. So monitoring with pulse oximetry is of prime importance in this routine procedure.
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Comparative analysis of intrathecal nalbuphine vs fentanyl as an adjuvant to bupivacaine for urological procedures p. 203
Kamakshi Garg, Pallavi Garg, Sunil Katyal
Background: Opioids have been used as additives to bupivacaine in spinal block to enhance their action and analgesia. The aim of the study was to assess the effectiveness of adding intrathecal nalbuphine or fentanyl as an adjuvant to bupivacaine in spinal anesthesia for patients undergoing the transurethral resection of the prostate (TURP). This is a single-center, prospective, double-blind, randomized study. Materials and Methods: Sixty men (40–80 years) undergoing TURP received an intrathecal injection with 2.5 mL of 0.5% hyperbaric bupivacaine with fentanyl 25 µg (Group 1) or nalbuphine hydrochloride 0.8 mg (Group 2) in this prospective, randomized, double-blind study. The onset and duration of sensory and motor block, hemodynamic parameters, and incidence of adverse effects were compared between the groups. Results: Patients in the nalbuphine group reported significantly prolonged sensory block (198.60 ± 16.8min) compared to patients in the fentanyl group (185.40 ± 22.2min), (P < 0.001). Similarly, patients in the nalbuphine group had a longer motor block (210.60 ± 19.8min) in comparison to those in the fentanyl group (194.40 ± 21min; P < 0.001). Intraoperative hemodynamic variability was comparable in both the groups. Postoperative pain was significantly higher in the fentanyl group (80%) as compared to the nalbuphine group (13.3%) (P < 0.001). Conclusion: Intrathecal nalbuphine is a safe and valuable alternative to intrathecal fentanyl for spinal anesthesia.
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Epidemiological profile of HIV patients attending ARTC of a tertiary care hospital in Jaipur, India p. 209
Sadhana Meena, Monika Rathore, Pragya Kumawat, Arpit Singh, Nikita Sharma, Manoj Kumar Gupta
Introduction: District Jaipur of Rajasthan has a high prevalence of Human Immunodeficiency Virus (HIV) and it comes under category B of HIV transmission. The geographical and sociocultural environments of different states of India are different; hence, the profile of HIV cases also differs from place to place. Area-specific data regarding the profile of HIV cases attending the biggest government hospital of Jaipur could be utilized by higher authorities for the implementation of control measures. Objective: The objective was to describe the sociodemographic profile of HIV cases and to find out the comorbidity of TB-HIV cases. Materials and Methods: The hospital-based, observational, and descriptive study was undertaken at a tertiary care teaching hospital of Jaipur from 1 January to 28 February 2019. Primary data were collected from 220 HIV-positive cases through an interview, and secondary data were collected from case records. Results: The maximum cases (40%) were in the age group of 31 to 40 years. Around 30% of cases were unmarried, widows, or divorced. Half of them were from the below poverty line (BPL) families. Only 9% of patients had a college education. Every third case reported was a housewife. Around 13% of cases were not aware of their spouse’s HIV status. HIV-TB coinfection was present in 20% of cases. Conclusion: The majority of cases were from the sexually active age groups and were poor, unmarried, widows, or divorced, and housewives. The spouse of every eighth case was unaware of the HIV status of their partner. Tuberculosis (TB) was the most common coinfection. This basic information would help policymakers formulate better information, education and communication and control measures that are area and population specific.
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COVID-19 Top

Perspective: COVID-19 and its effect on patients undergoing infertility treatment p. 213
Mini Mol Padmini, Rafiya S H Sangameshwari
The sudden pause in infertility following an outbreak of the coronavirus disease-2019 (COVID-19) pandemic felt like another loss for those who were trying to conceive. Infertility can also be classified as a disease and as such, not all infertility care procedures should be considered elective. There is complexity in defining essential versus nonessential treatment. Therefore, for all of those who were about to start IVF (in vitro fertilization) cycle after years of trying to conceive, frozen embryo transfer (FET) could be a possible solution. FET has the potential of separating fertilization from pregnancy. It means that the IVF cycle without “embryo transfer” (ET) can be carried out and the resultant embryo can be frozen. These frozen embryos could be transferred to the patient after COVID-19 pandemic subsides. This way, the patient can avoid the adverse effects of the virus on the pregnancy. A sudden pause in the fertility cycle may lead to a feeling of hopelessness among patients, with certain thoughts that “they will never be able to conceive or that their life will never be happy.” Indeed, short delays may not compromise fertility. Patients as well as their doctors should be prepared for a stress-free post-pandemic period for pregnancy. Thus, assisted reproductive technology (ART) may ensure that the virus spoils do not spoil their life expectations.
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Preparedness of a tertiary care hospital in Maharashtra, India on the background of CORONA pandemics 2020 p. 216
Badrunnesa Khatun, Kalyani Sen, Nitin Kadam
The coronavirus disease-2019 (COVID-19) has rapidly progressed across the nation since January 2020, with the United States having the highest number of cases in the world. On the background of the corona pandemic, it is the topmost priority to prepare a tertiary care hospital for planning a diagnostic screening, triaging, and management of patients and at the same time protecting healthcare workers and the environment. This article describes the infrastructures, hospital policy, and guidelines for giving quality and proper treatments to all needy patients. Aggressive screening at the corona screening desk and implementation of infection control measures are key elements for success.
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Acute hemiballismus in the absence of subthalamic nucleus lesion p. 222
Shreya Gudi, Tushar Kanti Biswas, Rucha Sane
A 68-year-old male, known hypertensive on irregular medication presented with sudden onset of involuntary movements of the left upper limb, in the form of severely violent, arrhythmic, and flinging large amplitude movements for 2 days, suggestive of hemiballismus. Magnetic resonance image of brain revealed a subacute nonhemorrhagic infarct in the posterior limb of the right internal capsule, but no lesion was noted in the subthalamic region. In traditional teaching, hemiballismus has been characterized as almost pathognomonic of a lesion in the subthalamic nucleus (STN). While a lesion occurring directly in the subthalamic nuclei can explain the onset of the movement disorder, a lesion occurring anywhere along the cortico-striatal pathway can also produce similar symptoms. The prognosis is benign in most cases, with almost all patients responding well to treatment and many having spontaneous remission. Our patient improved significantly following Tetrabenazine. Hemiballismus is as such a rare movement disorder. An elderly patient with sudden onset hemiballismus, indicating a vascular insult confirmed by subacute infarct in the posterior limb of the internal capsule, without any lesion in STN merits the report of this rare case.
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Endoscopy-guided intragastric balloon p. 225
Siddharth Mohanlal Jain, Mohan A Joshi
Obesity is one of the leading global health problems in the world today. It is considered a major risk factor for many serious diseases. To treat this risk factor, doctors have developed invasive and noninvasive therapeutic methods. One of these methods is the intragastric balloons (IGBs), which are known by some studies to be efficient, safe, and easy. Here, we report five cases of obese patients (three women and two men) treated by saline-filled gastric balloon insertion at our hospital. The balloons were placed endoscopically in the stomach then inflated with saline + methylene blue. After the procedure, patients were discharged within a few hours. The IGB was removed 6 months later. All patients were followed for a minimum period of 6–12 months. The insertion of a gastric balloon gives good results in the reduction of weight in all five cases; it seems that the use of gastric balloon insertion in obese patients is an effective technique for weight loss.
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Safeguarding the health of ship passengers and their disembarkation in the ongoing coronavirus disease-2019 pandemic p. 230
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
The ongoing coronavirus disease-2019 (COVID-19) pandemic has become one of the global public health emergencies requiring immediate and urgent attention. As the most common mode of disease transmission is through close contact and droplets, it has been advocated to avoid any unnecessary travel. It is ideal that, if the trip has not started, it should be deferred till the pandemic settles, while in case, the journey has already started, it is the responsibility of the ship authorities to safeguard the health of the onboard passengers. The first and foremost thing for all the ships who are planning for an international voyage or are stranded midway is that all these ships should formulate a detailed outbreak management plan. In conclusion, ensuring safety of passengers in the ship and their safe disembarkation is one amongst the top priorities in the ongoing battle against the COVID-19 pandemic. It is high time that all the ship authorities are well prepared and have a detailed outbreak management plan to minimize the chances of acquisition of infection and also onward transmission.
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Major factors associated with worldwide dermatophytosis predominance p. 232
Falah Hasan Obayes AL-Khikani
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