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   Table of Contents - Current issue
Coverpage
April-June 2020
Volume 7 | Issue 2
Page Nos. 53-104

Online since Friday, June 19, 2020

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EDITORIAL  

Raising the abortion limit to 24 weeks: A welcome step, but with ethical challenges p. 53
Sushil Kumar
DOI:10.4103/mgmj.MGMJ_53_20  
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ORIGINAL ARTICLES Top

To evaluate the buffering capacity of various drinks commonly available in India p. 56
Vanitha U Shenoy, Saimanaaz Shaikh, Sumanthini Margasahayam Venkatasubramanyam, Jayeeta Verma, Padma Chavan, Santosh Gawali
DOI:10.4103/mgmj.MGMJ_29_20  
Introduction: Consumption of carbonated and health drinks and fruit juices containing acid, as one of the ingredients, can lead to erosion of the tooth. Aim: The purpose of this study was to measure buffering capacity of commonly available drinks and their titratable acidity. Materials and Methods: Sixteen commonly available drinks were taken and divided into four groups (sports/energy drinks, carbonated drinks, fruit juices, and water). Each group comprised four drinks. Their initial pH was measured with pH meter and their titratable acidity was measured, both by adding 0.1M NaOH into 30 mL of each drink, in the increments of 1 mL, till the pH raised to 5.5 and 7.0, respectively. Statistical Analysis: The volume of NaOH required to raise the pH to 5.5 and 7.0 was recorded in each group. The data were subjected to analysis of variance (ANOVA) followed by Tukey’s post hoc test. Results: Study groups showed significantly lower initial pH compared to the control group. Intergroup comparisons within study groups showed no significant differences with respect to their initial pH. Titratable acidity of energy drinks was found to be maximum to reach the pH 5.5 and even for pH 7. Titratable acidity was the minimum with carbonated drinks to reach pH 5.5 and with fruit juices to reach pH 7.0. Conclusion: No significant differences were observed between the energy drinks–carbonated drinks, energy drink–fruit juices, and carbonated drink–fruit juices with respect to their initial pH. Energy drinks had the most erosive potential due to their significantly greater buffering capacity as compared to carbonated drinks and fruit juices.
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Serum lipid profile in patients with cholesterol containing gallstones: A study from South India p. 63
Prema Saldanha, Priya Suneja, Anand Raj
DOI:10.4103/mgmj.MGMJ_42_20  
Background: Cholelithiasis is a common disease and notable advances have been made in studying the possible causes and mechanisms involved. It is not only important to study the prevalence of gallstone disease regionally, but also to explore the demographic and biological markers related to the development of gallstone disease, so that appropriate preventive measures may be undertaken. Many previous studies have shown a positive correlation between altered lipid profile and formation of gallstones, whereas some show no definite correlation between the two. Objective: This work aimed to study the association of lipid profile with cholelithiasis in our geographic region. Materials and Methods: This was a retrospective study of cases who underwent cholecystectomy for cholelithiasis, obtained from the archives of the Department of Pathology. The lipid profiles of these patients were retrieved from the laboratory records and analyzed. Results: The number of patients with mixed stones (cholesterol and pigment) accounted for 85% and pure cholesterol stones were seen 15% of the cases. Deranged lipid profile was observed in 57 (95%) of the cases. The most common abnormality was increased levels of low-density lipoprotein /very low density lipoprotein with decreased high-density lipoprotein. Conclusion: In this study, it was found that a significant number of patients with cholesterol-containing stones had a deranged lipid profile. This suggests that hyperlipidemia plays an important role in the lithogenesis of cholesterol-rich gallstones.
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Transperitoneal laparoscopic nephrectomy for benign nonfunctioning kidney: Our experience with 84 cases p. 68
Piyush Singhania, Kush Shah, Aman Agarwal, Neeraj Tiwari
DOI:10.4103/mgmj.MGMJ_37_20  
Background: The transperitoneal laparoscopic nephrectomy provides an optimal working space. It facilitates orientation by extending identifiable anatomic landmarks. The study evaluates the safety, outcome, and complications of the procedure. Materials and Methods: A total of 84 patients with benign nonfunctioning kidney admitted from April 1, 2015 to March 31, 2019 in the Department of Urology, MGM Medical College and Hospital, Navi Mumbai, India were considered for study purposes. The exclusion criteria of the study included uncorrected coagulopathy, active urinary tract infection, pregnancy, and severe cardiopulmonary disease. Preoperative imaging included digital X-ray, kidney ureter bladder, ultrasonography, intravenous pyelogram, computed tomography, intravenous urogram, micturating cystourethrogram, and diethylenetriaminepentaacetic acid renal scan. All operated patients were evaluated for intraoperative and postoperative complications. Results: The mean age of patients was 40.76 years. Of 84 patients, 60 were men and 24 were women. Patients had complaints of ipsilateral flank pain 76 (90.47%), lower urinary tract symptoms 34 (30.95%), and hematuria 18 (21.42%). Causes of benign nonfunctioning kidney were obstructive uropathy secondary to stone in 62 patients (73.81%) followed by neglected pelvic ureteric junction obstruction in 8 (9.53%), renal tuberculosis in 6 (7.14%), chronic pyelonephritis in 6 (7.14%), and renovascular hypertension in 2 (2.38%) patients. Seven patients required conversion to open surgery, secondary to adhesions in four patients, instrument failure in one case, and bleeding in two cases. The mean stay of the patient in the hospital was 4.38 days. Various types of complications occurred in five patients: colonic injury in one, wound infection in three, and incisional hernia in one. Conclusion: Transperitoneal laparoscopic nephrectomy is an effective procedure with minimal morbidity, hospital stay, rapid recovery, and better cosmesis making this the gold standard technique for nephrectomy.
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Practical skills evaluation of undergraduate medical students by an objective structured practical examination (OSPE): An effective tool for formative assessment in microbiology p. 74
Gurjeet Singh, Raksha Singh
DOI:10.4103/mgmj.MGMJ_45_20  
Background: Objective structured practical examination (OSPE) has ended up being a decent choice to beat traps of customary technique for evaluation. OSPE is not typically used in medical colleges in India in view of requirements of assets. Consequently, the two teachers and students are very little mindful of the OSPE model. Consequently, we led this examination to make mindfulness on the OSPE strategy and break down Student’s assessment with respect to the technique. Aims and Objectives: This study was conducted to know how the subjectivity of conventional practical methods of evaluation in medical education is overcome in OSPE. Materials and Methods: A total of 130 second-year professional MBBS students were included in the study. The skills of the medical students were assessed on the basis of their performance. Four stations were formed, of which two were procedure stations and other response stations. Students were evaluated using the OSPE model. OSPE additionally broke down to see the lacuna in any progression or any inquiry with respect to students. Traditional techniques and procedural and response stations in OSPE were investigated to learn the knowledge, skill, and competency of students in this subject. Student’s opinion about the new method was collected through a questionnaire and analyzed. Results: A total of 130 students from MBBS’ second professional year were included in the study. Of which, 91.54% of students felt that they were given adequate time at each station adequate, 71.54% responded that they were prior sensitized about OSPE, 93.08% responded that the exam was not stressful, 94.62% said that the OSPE was very much organized, applicable, and uniform, 80.77% said that the exam covers the appropriate knowledge than the traditional examination, and 76.15% opined that such type of exams should be included in the future as a method of formative assessment in practical examination. Conclusion: It was proved in this study that OSPE had overcome the subjectivity in conventional methods. The students showed lacunae in some steps of the exercise, which were informed to the teachers for more concentration on those steps. The students had good knowledge and skills but less competency, our study highlights the implementation of OSPE for formative assessment in the curriculum of undergraduate medical education, so that students can achieve more skills and knowledge to improve their competency.
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SHORT COMMUNICATION Top

Ensuring prevention of transmission of corona virus disease 2019 from animals to humans p. 79
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mgmj.MGMJ_35_20  
The details about the origin of the Corona Virus Disease-2019 (COVID-19) outbreak is still not clear and there are multiple gaps which needs to be bridged to prevent the re-introduction of the virus in the future. It has been hypothesized that bats were the ecological reservoir, while the transmission of the virus to humans has been via an intermediate animal host, which is not yet recognized. It is of paramount importance to prevent the probability of disease transmission from animal hosts to human, either in live animal markets or where animal products are sold. Moreover, the safety of the people working in these markets as employees or vendors are also extremely important. In conclusion, the pace with which COVID-19 pandemic is spreading, it becomes extremely important to ensure that all forms of transmission from animals to humans in the future should be discouraged. This will essentially require counseling of the workers and buyers about the do's and don'ts in animal market and better supervision of the ongoing activities.
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PERSPECTIVE ARTICLE Top

Perspectives of PhD research: The key components for assessing its quality p. 81
Bani B Ganguly
DOI:10.4103/mgmj.MGMJ_39_20  
The number of PhD theses approved for the doctoral degree is on a steady rise in different disciplines across the globe. However, the quality may not meet the requirement of the academia and industries, especially in biomedical research and development (R&D), and that is not only contributing to the escalated problem of unemployment of such population having higher degrees but also diminishing the quality of education and research. Therefore, a harmonized approach shall be adopted by the universities for an examination of the quality of PhD theses and approval of the PhD degree. Quality of PhD theses of all universities, including central, state, private, and deemed to be (private or public), which are governed by the authorized regulators, such as University Grants Commission (UGC) in India, is important for the PhD students as well as mentors and granting institutions. On the basis of the current state of the art, concepts have been conceived to capture the merit of PhD degree or higher education. Evaluation of the quality of PhD can be achieved through the articulated examination system of the three key factors such as the merit of the PhD candidate, facility and position of the PhD mentor or guide, and the examination system of the granting universities. The discussion of this article has been concentrated in the quality of PhD in biomedical sciences to assess a comprehensive picture of PhD or higher education, which would not only be helpful for judging the merit of PhD but also redefine and implement policies by the regulators of higher education for continual improvement.
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REVIEW ARTICLE Top

Human vaccines industry in china, 2019: Part II p. 86
Prasanta Kumar Ghosh
DOI:10.4103/mgmj.MGMJ_48_20  
There are a large number of private manufacturers of vaccines in China. Most of the Chinese private companies manufacturing vaccines were established in the decade of 1990 and thereafter. Local investors came forward to set up manufacturing facilities in an environment of China’s growing demand for human vaccines and for exports. There are at present about 34 companies operating in the private sector, including MNCs. In this review, profiles of 25 private Chinese companies have been brought out. The turnover of vaccines manufactured in China is estimated at between US$3.50 and US$3.95 billion in 2019. Although the turnover of the vaccine industry was about 2.7%–3.1%, when compared to its pharmaceutical industry in value terms, it is a very important segment of healthcare infrastructure of the country.
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CASE REPORTS Top

Primary hyperparathyroidism: diagnostics and surgical management p. 97
Leszek Sulkowski, Maciej Matyja
DOI:10.4103/mgmj.MGMJ_32_20  
Primary hyperparathyroidism is an endocrinological pathology of parathyroid glands. Its predominant form is a single parathyroid gland adenoma. We present a case of a 53-year-old patient, who was referred with primary hyperparathyroidism. She underwent ultrasound and sestamibi radionuclide scanning, and was offered surgery. The postoperative histopathological examination proved the presence of parathyroid gland adenoma. Patients managed with primary hyperparathyroidism require preoperative localization of enlarged, usually single parathyroid glands. Diagnostic modalities include ultrasounds, computed tomography scanning, and sestamibi radionuclide scanning. Parathyroidectomy is a recommended treatment modality for each stage of primary hyperparathyroidism, despite organ involvement, severity of hypercalcemia, and parathormone concentration. Significant bone remineralization is observed postoperatively. Preoperative localization of the enlarged parathyroid gland is crucial. Primary hyperparathyroidism requires surgery for definitive treatment. Surgery, although challenging, leads to a cure.
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Distal interstitial 1p36 deletion syndrome in a case of global developmental delay with multiple congenital malformations p. 101
Suvarna Magar, Madhuri Engade, Shirish Bhartiya, Anish Tamrakar
DOI:10.4103/mgmj.MGMJ_44_20  
We report a 1-year-old girl child with a global developmental delay with multiple congenital malformations who presented with the abnormalities including postnatal growth failure, feeding difficulties, seizures, developmental delay, cardiovascular malformations, microcephaly, vertebral segmental defects in the cervical region, Hirschsprung disease, corpus callosal hypoplasia, bilateral fifth finger clinodactyly, and dysmorphic features, including the frontal and parietal bossing, posteriorly rotated ears, hypertelorism, straight eyebrows, and a prominent, upturned broad nose with a long philtrum were noticed. Owing to global developmental delay and multiple congenital malformations, the first-line diagnostic test considered was chromosomal microarray, and it revealed a pathogenic copy number variation in chromosome 1, short arm, 7.3Mb deletion from segment 1p36.32 to 1p36.22. It is a descriptive study undertaken for clinical characteristics and diagnostic evaluation in a girl with global developmental and multiple congenital malformations. The phenotypic features described in our patient could be matched with the genotype on microarray evaluation and were comparable with various studies recorded in literature.
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