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   Table of Contents - Current issue
Coverpage
July-September 2020
Volume 7 | Issue 3
Page Nos. 105-162

Online since Tuesday, August 18, 2020

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EDITORIAL  

Resident doctors’ duty hours: A questionnaire-based study in national and international perspective p. 105
Sushil Kumar, Akriti Gupta
DOI:10.4103/mgmj.mgmj_70_20  
Introduction: Most serious patients among the poorest of the poor class are treated in the hospitals attached to medical colleges. Although there are senior and experienced doctors available, there is no denying the fact that resident doctors are the backbone of medical care. We cannot even dream of running these hospitals without them especially when coronavirus disease-2019 (COVID-19) is spreading like a wildfire across the globe. As far as the mental health of the resident doctors is concerned, often there are complaints of burnouts, depression, medical error, suicidal ideation, and leaving the course halfway, among them. We carried out a small questionnaire-based study to find out the viewpoint of the residents. Materials and Methods: An anonymous survey in respect of work hours and call schedules was administered to 50 junior residents. The results were analyzed. The faculty viewpoint, regulations in different countries, and regulatory bodies were also taken into account to present a balanced view and recommendations. Results: A total of 50 residents were surveyed. 64% of the residents worked for around 81–100h per week. 58%residents get 6h of uninterrupted sleep per day. 86% of the residents felt that extended working hours do not improve patient care. 82% of residents felt that there is no gain of skills with extended working hours; also, it does not leave them any spare time to study. 64% of the residents (mostly first-year postgraduate [PG] students) felt that most of their time is used for paperwork, which has no bearing on their skill development or knowledge. 16%–24% of residents felt that the extended working hours are affecting their mental health. Some of the residents felt that their relationship with coresident also affects their work. 74% of the residents admitted that they were asked to work more than 24h continuously quite often. 84% of the residents felt that they should get more time for leisure activities. Conclusion: There is a need to formalize working hours and to reduce paperwork for the residents to keep them in good mental health. A structured and supervised work schedule for the residents especially for the first-year PG students is the need of the hour. We need to balance education, patient care, and health of the young resident doctors while considering their work schedule.
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ORIGINAL ARTICLES Top

In silico drug repurposing: An antifungal drug, itraconazole, repurposed as an anticancer agent using molecular docking p. 110
Sanika Dhorje, Poonam Lavhate, Amrita Srivastav
DOI:10.4103/mgmj.mgmj_31_20  
Introduction: In recent years, increased cancer incidences and death rates due to it, have turned cancer to be a major problem worldwide. Approximately more than 7 million people globally die from cancer. Among the various types of cancer, breast cancer is the most prevalent type of malignant neoplasms among the women. Owing to the increasing triple-negative breast cancer (TNBC) cases per year, there is a high demand for the development of new potential drugs within a short period. Objectives: The objectives of this study were to overcome the traditional drug discovery challenges and to deal with hazardous diseases with potential drugs within a less time using molecular docking as the most important bioinformatics tool used for computer-aided drug designing (CADD). Materials and Methods: For designing drug against TNBC, Smoothened (SMO) protein involved in the hedgehog pathway is selected, and an antifungal agent itraconazole is taken as a drug, which already exists but is repurposed using bioinformatics tools such as National Centre for Biotechnology Information (NCBI), Protein Data Bank (PDB), KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway database, Computed Atlas of Surface Topography of proteins (CASTp)/metaPocket, PubChem, DrugBank, MarvinView, Discovery Studio, and AutoDock tool. Similarly, the effect of the drug was tested in vitro on TNBC cell line (MDA-MB-231) using 3-(4, 5-dimethythiazol-2-yl)-2, 5-diphenyl tetrazolium bromide (MTT) assay. Results: It was observed that cell viability decreased when different drug concentrations were used against TNBC cell lines in vitro as compared with the control sample, which lacked the drug sample. The cell viability observed was 100% in the control sample, 91% in 15.625 µM drug concentration, 71.5% in 31.25 µM drug concentration, 65.25% in 62.5 µM drug concentration, 54.75% in 125 µM drug concentration, 40.5% in 250 µM drug concentration, and 43% in 500 µM drug concentration. Conclusion: Repurposing of drug with the help of molecular docking is an effective method of drug development, which reduces time and cost of development of drug, and as it has already been approved, its safety measures are already known to make them safe to use. It is concluded that itraconazole shows an inhibitory effect on SMO, and thus it can be used as an anticancer agent.
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Assessment of biomarkers of endothelial dysfunction in patients with angiographically proven coronary artery disease p. 119
Sanjay G Guddetwar, Zunjarrao G Badade, Dhananjay V Bhale, Shafaat Hussain Talib, Vandana Z Badade
DOI:10.4103/mgmj.mgmj_41_20  
Introduction: The endothelium plays an important role in vascular homeostasis. Endothelial dysfunction leads to vasospasm, vasoconstriction, excessive thrombosis, and abnormal vascular proliferation. Endothelial dysfunction may be present in asymptomatic individuals, those could later develop hypertension, diabetes mellitus, and heart-related problems, which is one of the major causes of morbidity and mortality in India. The markers of endothelial dysfunction studied in this work are high-sensitivity C-reactive protein (hs-CRP), urine microalbumin creatinine ratio, and associated other markers such as lipid profile and fasting plasma sugar. Aims and Objective: The primary aim of this study was to assess biomarkers of endothelial dysfunction in patients with angiographically proven coronary artery disease (CAD). The secondary aim of this study was to estimate the levels of serum hs-CRP, urine microalbumin creatinine ratio, lipid profile, and fasting plasma sugar level in patients with angiographically proven CAD. Materials and Methods: This cross-sectional descriptive study was carried out from May 1, 2017 to April 30, 2019, at MGM Medical College, Aurangabad on approval of the Institutional Ethics Committee. A total of 231 patients with CAD of both sexes aged 21–80 years were included in the study. Serum hs-CRP was estimated by immunoturbidimetry, lipid profile by microslide method on VITROS 5600 (Ortho Clinical Diagnostics, Raritan, NJ, USA), urine microalbumin by immunoturbidimetry, urine creatinine by enzymatic reaction, and urine microalbumin creatinine ratio is calculated. Results and Discussion: hs-CRP was elevated in smokers, especially in triple vessels as compared to single and double vessels in patients with CAD, whereas the difference was nonsignificant between two- and three-vessel disease groups. In this study, we found an increased association between patients with microalbuminuria and abnormalities in serum lipoproteins. These lipid abnormalities include a lower high-density lipoprotein (HDL) level as well as higher values for low-density lipoprotein (LDL) and total triglycerides. Conclusion: This study showed that hs-CRP and urine microalbumin creatinine ratio levels were higher especially in smoker patients with CAD. There was an increase in levels of serum triglycerides, hs-CRP, LDL, and reduced HDL cholesterol levels in patients with CAD.
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A study of knowledge and attitude about HIV/AIDS among college-going rural youths in Vasai in Palghar District of Maharashtra p. 126
Quincy Vaz, Prasad Waingankar
DOI:10.4103/mgmj.mgmj_24_20  
Background: Knowledge and a positive attitude are necessary for the successful reduction in the prevalence of and stigma surrounding human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). The rural youth is a vulnerable group because of a lack of knowledge and maturity, misconceptions, cultural beliefs, and taboos about HIV/AIDS. Objective: The study aimed to assess knowledge and attitude about HIV/AIDS among college-going rural youths in Vasai in Palghar district of Maharashtra. Materials and Methods: The proportionate allocation approach was used with the stratified random sampling technique to select a 10% sample from 5000 rural students from two colleges in Vasai. A total of 512 students from various academic streams consented to participate. A pretested, semi-structured questionnaire comprising 50 questions (in English only) was administered. It included details about their sociodemographic status, economic background, knowledge, and attitude about HIV/AIDS with a scoring system. Data were analyzed using Excel and Epi Info. Results: Of the total of 512 students, 89.78% of males and 85.37% of females were aware of HIV/AIDS. The science students obtained a mean score of 8.49, whereas the nonscience students obtained a mean score of 6.93. Only 57 students could write a few correct symptoms of HIV/AIDS. About 65.82% of students feel that testing is important, but only 33.01% were willing to get tested. When asked about shaking hands with or touching people living with HIV/AIDS (PLHAs), 79.69% said that merely touching does not transmit HIV/AIDS, but only about half of the students (51.95%) would actually shake hands with or hug a PLHA. Interpretation and Conclusion: Unlike many other studies, where knowledge was poor and therefore attitude also reflected poorly, rural youth in Vasai has fair knowledge, but their attitude toward HIV/AIDS/PLHA is unfavorable. Although Vasai is rapidly developing, and literacy levels are increasing, the misconceptions and social stigma persist. Therefore, having adequate knowledge is not sufficient; the attitude has to change as well.
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Prevalence of musculoskeletal symptoms and quality of life in housekeeping workers of a tertiary care hospital in Navi Mumbai, India: A descriptive study p. 133
Palak Chheda, Swapna Rajan Sreeraj
DOI:10.4103/mgmj.mgmj_26_20  
Context: Prevalence of musculoskeletal disorders (MSDs) in India is 90%, leading to loss of working hours, poor quality of life (QoL), and reduction in productivity of the life of the employers. Housekeeping profession, considered a major workforce industry, requires manual labor demanding awkward postures and repetitive movements, leading to MSDs and impacting QoL. Objectives: The objective of this study was to find the prevalence of the symptoms of MSDs and QoL in the housekeeping workers of the hospital. Settings and Design: A descriptive study was carried out among housekeeping workers of MGM Hospital, Kamothe, Navi Mumbai, Maharashtra, India. Materials and Methods: With Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) and WHO-QOL-BREF scale, 82 housekeeping workers were contacted, and an interview-based session was held. Statistical Analysis: Descriptive analysis and graphical representation were carried out using MS Excel. Results: Of the participants, 68.29% were females with a mean age of 42.28 ± 7.4 years, and 31.70% were males with a mean age of 42.04 ± 8.3 years. The prevalence of the symptoms of MSDs was higher in knees followed by lower back and lower leg. Females (80.36%) were affected more than males (61.54%). WHOQOL-BREF for QoL showed a moderate impact without much gender difference. Conclusion: The study concluded that there is a high prevalence of the symptoms of MSDs in housekeeping staff, more likely in the lower back, knee, and lower leg, and WHO QOL-BREF shows comparable mean scores among males and females.
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REVIEW ARTICLES Top

Role of harmonics and subharmonics in peripheral pulse analysis p. 141
GD Jindal, Sushma N Bhat, Manasi S Sawant, Alaka K Deshpande
DOI:10.4103/mgmj.mgmj_47_20  
Elastic compliance of the blood vessels contributes high-frequency components in the peripheral pulse, which are analyzed with the help of the power spectral density of the signal. The frequency corresponding to heart rate in a subject is called his fundamental harmonic or first harmonic, frequency twice the heart rate is called second harmonic, and so on. The contribution of these harmonics is assessed by performing Fourier transform on the peripheral blood volume or flow pulse signal for sufficient duration, which yields power spectral density of the peripheral pulse. Dedicated software, known as pulse harmonic analyzer, has also been developed for performing harmonic analysis of the peripheral signal. It not only yields a contribution of higher harmonics in the pulse but also subharmonics (frequencies smaller than the heart rate of the subject). Researchers have observed suppression of second harmonics in subjects aging more than 30 years, suppression of high-frequency components in the power spectral density of the pulse in the coronary artery disease and enhancement of the first harmonic in hypertensives and subjects susceptible to diabetes during the past four decades. Subharmonic components are observed to be related to variability in heart rate, pulse volume, and pulse morphology, which has the potential to become a method of choice for continuous real-time variability monitoring in intensive care units. These observations are reviewed in this paper briefly.
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Human vaccines industry in China, 2019: Part III p. 148
Prasanta Kumar Ghosh
DOI:10.4103/mgmj.mgmj_51_20  
There are five multinational companies (MNCs), operating in China in the vaccine field. These companies have made a sizable investment in China on various counts, including the establishment of local offices, teaming up with certain Chinese companies, and some have also made a sizable investment in R&D for pursuing both basic types of research as well as application-oriented research and/or manufacturing or repacking facilities. The MNCs sell their proprietary vaccines either directly or have teamed up with Chinese companies for sale.
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CASE REPORTS Top

Immune thrombocytopenic purpura in pregnancy p. 155
Narayani Kalnawat, Archana Chatterji
DOI:10.4103/mgmj.mgmj_55_20  
We present a case of a 27-year-old primigravida, a known case of immune thrombocytopenic purpura (ITP), who is presented in our outpatient department in latent labor at 36 weeks of gestation with platelet count 36,000/µL. She has been on prednisolone since the first trimester and has a history of platelet transfusion at 28 weeks of gestation. She was given platelet transfusions during labor, and delivered vaginally a male baby with an appearance, pulse, grimace, activity, and respiration score of 8/10 and 10/10 with normal platelet counts at birth and 24h later. She was discharged on the 7th postnatal day. The aim of this case report was to discuss ITP in pregnancy, its clinical presentation, and management.
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Transhepatic venous approach to permanent pacemaker implantation in a patient with no conventional access site p. 158
Nitesh Karnire, Pravat K Dash, Nishita C Pujary
DOI:10.4103/mgmj.mgmj_52_20  
Permanent pacemakers are generally done through subclavian venous access. We present a case of transhepatic venous approach to a permanent pacemaker in a patient who had bilateral obstructed subclavian vein and superior vena cava (SVC) secondary to previous permanent pacemaker infection.
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LETTER TO THE EDITOR Top

Role of EEG biofeedback in the treatment of adults with attention-deficit hyperactivity disorder in the era of COVID-19 pandemic p. 161
Chidiebere Emmanuel Okechukwu
DOI:10.4103/mgmj.mgmj_61_20  
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