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   Table of Contents - Current issue
January-June 2020
Volume 25 | Issue 1
Page Nos. 1-58

Online since Tuesday, April 14, 2020

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Temples of rare cult Highly accessed article p. 1
Anupama Gupta
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Journal of Mahatma Gandhi Institute of Medical Sciences: A silver journey of 25 years p. 4
OP Gupta
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Evidence-based intervention to prevent anemia among women of reproductive age group in developing countries Highly accessed article p. 6
Mubashir Zafar
Background and Objective: Anemia in developing countries is the biggest public health problem. Reproductive age group women have high prevalence. The objective of the present study is to determine the cost-effective intervention for the reduction of anemia among women of reproductive age group. Methodology: A review of the literature was done for identifying various preventive strategies regarding anemia and its implementation barriers in low- and middle-income countries. Google Scholar, PubMed, Web of Science, and Scopus were used as search engines.Results: The result of the review shows that the most cost-effective method for the prevention of anemia among women is iron fortification of food, iron supplementation, community-based health promotion of healthy nutrition. Women empowerment is the best tool for the implementation of all the above method for the prevention of anemia. Conclusion: Community-based intervention is the most effective method for reducing maternal anemia. It includes health promotion and women empowerment. There is a need to develop policies to improve the health promotion activities and involvement of women in society.
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Paradigm shift in the pharmacological treatment of type 2 diabetes mellitus p. 11
Tejal Lathia
The options for pharmacological management of type 2 diabetes mellitus have exploded over the last decade or so. Availability of a variety of new drugs, oral as well as injectable, has made the choice of treatment more complex and challenging. Over a decade or so ago, glycemic (glucometabolic) control was the main target of treatment in patients with type 2 diabetes mellitus – usually with metformin, sulfonylureas (SU), thiazolidinediones, and insulin (the traditional quartet). There is conflicting evidence on the cardiovascular (CV) effects of the traditional quartet of drugs. The almost serendipitous benefit of sodium-glucose transporter 2 (SGLT2) inhibitors on CVD and kidney disease in patients with type 2 diabetes mellitus has revolutionized the way we view the treatment of diabetes. . What the physician needs to remember when prescribing this drug is – right patient and right intent.
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Drug resistance in tuberculosis: A clinician's view p. 15
Kamal Kishor Chopra
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Delay in starting therapy in drug-resistant tuberculosis – An insight p. 19
Ambarish Joshi, Surya Kant, Ramawadh Singh Kushwaha, Pranav Ish
Introduction: The Revised National Tuberculosis Control Programme (RNTCP) ensures a prompt diagnosis and effective treatment of all tuberculosis (TB) patients with drug-resistant TB via decentralized drug sensitivity testing (DST). This study was taken in to find out the cause of delays in initiation of treatment. Material and Methods: This cross-sectional observational study included a questionnaire-based interview and retrospective analysis of records of the concerned patients with an aim to explore the reasons associated with this delay. Results: A delay was arbitrarily defined as a time period of more than 15 days from the date of sputum collection for DST to the date of admission. It considered of two parts, one due to lapse in system regarding implementation of program and other due to the lapses in the part of the patient. Out of 402 patients enrolled in the study, 252 (62.7%) sought treatment after the prescribed period and were categorized as delayed and comprised the Group I of study. The remaining 150 (37.3%) were those who sought treatment within the prescribed period and were and were termed in-time treatment seekers and thus comprised Group II of study. Delay in communication of results to DOTS centre and in-patient tracing was the most common reason for delay while unwillingness to avail treatment against the expectation was the least common reason. Conclusions: Undefined time for communication of DST results and patient tracing in PMDT services are the major cause of delay. Strengthening the communication skills of the care providers through expanding DST services at sub-district levels, regular training of care providers, setting district level information cells, creating mobile apps, and involving volunteers who are representatives of the local community is the need of the hour.
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Investigation of H1N1 influenza outbreak in a remote hilly region of North India p. 23
Vijay Kumar Barwal, Hari Ram Thakur, Bharat Bhushan, Shishu Pal Singh Thakur, Ankit Chaudhary, Gopal Ashish Sharma
Background: Influenza A/H1N1/2009 Pandemic strain is one of the reemerging viral diseases. Localized outbreaks of various magnitudes continue to occur globally as well as in India. An outbreak of this disease took place in a remote area of North India. We investigated it to find out the etiology and distribution and recommend appropriate control measures. Materials and Methods: On urgent directions from the State Health Department, a team was constituted to investigate the outbreak. The team mapped the area and undertook house to house search of cases on 17th–19th May 2017. Line listing of cases was prepared. Respiratory samples of 13 symptomatic cases were taken. Eight blood samples were also collected for viral serology and blood cultures. Results: Line listing consisted of 61 cases. Attack rate was 25.2/1000 population. Mean age was 13.9 years with a median of 4 years. All cases had fever, followed by cough (67.2%) and sore throat (44.3%). Case–fatality ratio was 1.6%. Epidemic curve showed a common source continuous epidemic with limited spread. The average incubation period was 5 days. Four samples were positive for Influenza A/H1N1/2009 Pandemic strain and two were positive for Influenza A (nonswine). Conclusion: It was a confirmed outbreak of pH 1N1. A similar outbreak here in April 2010 suggests the endemic presence of this virus, and in future, as the susceptible population again rises to a threshold level, another outbreak may occur in this area. Utmost priority should be accorded for continuous monitoring and surveillance along with intensified IEC activities.
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Assessment of the prevalence of polycystic ovary syndrome among the college students: A case–control study from Kolkata Highly accessed article p. 28
Madhumati Chatterjee, Soma Aditya Bandyopadhyay
Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. Of late, the disease is on its rise due to environmental changes as well as lifestyle disorders, affecting 4%–26% of adolescent and young women all over the globe. Initially, this condition is asymptomatic in young girls, progressing toward menstrual irregularities, obesity, hyperandrogenism in late puberty and eventually developing insulin resistance, hypertension, type 2 diabetes, cardiovascular diseases, and infertility around middle age. Aims: Early diagnosis is necessary for early intervention, including lifestyle modifications to prevent the immediate and chronic consequences of PCOS. Materials and Methods: Our study design was of a cross-sectional questionnaire-based survey, conducted from September 2017 to March 2018 to investigate the prevalence of PCOS and its association with body composition variables. The study population comprised randomly chosen students (age group 18–20 years) of all discipline. The data were collected from the students using structured questionnaire with Rotterdam's criteria, and anthropometric measurements were taken using standard techniques. Results: Approximately 28% of the college students were found to be at high risk of developing PCOS. More than 85% of the PCOS cases had oligomenorrhea, 19% were hirsute, 41% had acne, 63% had emotional disturbance, and 22% with a positive family history. Furthermore, the body mass index of the PCOS students demonstrated a trend of Grade 1 obesity than the normal females of the same age group. Conclusion: The present study is an attempt to create increased awareness among the students for early and accurate diagnosis, which is the primary step in managing PCOS.
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Determinants of surgically induced menopause in rural North Karnataka p. 33
Sudhirgouda Honagouda Patil, Naresh Kumar Tyagi, Jang Bahadur Prasad
Objective: The objective of the study was to quantify the effect of surgically induced menopause (SIM) on quality of life as assessed by religion, body mass index (BMI), sexual problem, menstrual history, blood spotting after intercourse, menopausal symptoms, and psychological disorder in the age group of 40–55 years of women. Materials and Methods: In this cross-sectional study, 712 rural women, comprising of 40 women (aged 40–55 years) with SIM, were surveyed, by inverse cluster sampling with proportional to population size. The aim was to study SIM and its determinants; menopause anthropometric data, menopause symptoms, and associated psychosocial symptoms. The data was analyzed using bivariate and multivariate techniques. Results: Around 6.4% of Hindu women had SIM, followed by Muslim (6.2%) and others (1.1%). SIM was significantly high in BMI group <25. The differences of SIM in regularity of menstruation were significant. Similar results were observed in sexual problem, menstrual flow, blood spotting after intercourse, blood spotting between periods, pain in periods, physical and mental exhaustion, heart discomfort, sleep problem, irritability, and dryness of the vagina. The sexual activity significantly hampered after SIM, further, unadjusted Odds Ratios (ORs) were not in line with adjusted OR. With regularity of menstruation problem, the SIM increases significantly, as indicated by adjusted and unadjusted ORs, the similar results were seen by menstrual flow and blood spotting after intercourse. The SIM by adjusted and unadjusted ORs was similar in other determinants. The Logistic regression model has been calibrated for sensitivity and specificity above 90% and accuracy as high as 97.8%. The modulated probabilities have been provided for the users of the model. Conclusion: The results of the bivariate analysis of surgical menopause by its covariates and regression model constructed are valuable for health-care providers, as reference for diagnosis, and to pacify patients for consequences of the prognosis.
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Trend and seasonality of infectious diseases – An overview from a tertiary care hospital of West Bengal, India p. 39
Rammohan Roy, Baisakhi Maji, Anima Haldar, Tutul Chatterjee
Background: Most of the developing countries still suffer from a high burden of communicable diseases. The paucity of proper data about the current trends and seasonal variations of different infectious diseases (IDs) further prevents the policy makers from devising an effective, preventive, and curative response. Hospital ID wards are a useful source of surveillance data that can indicate changing health-care requirements. Materials and Methods: A retrospective analysis of inpatient hospital database of past 5 years (January 2014–December 2018) was done to identify the pattern and trend of different IDs including seasonal variations. Results: Among 127,762 admissions during 2014–2018, diarrheal diseases (87%) were most common, followed by dengue (6.6%), chicken pox (2.4%), measles (1.6%), and diphtheria (1.2%). Measles and chicken pox cases had shown peak during February–May months, whereas dengue in September–October, and swine flu cases were at peak during the winter season. Over the past 5 years, the admission rate of measles cases showed a cyclical rising trend, chicken pox showed an inclining trend, whereas tetanus showed a declining trend. The admission trend of diphtheria cases was more or less similar throughout consecutive years except a fall in 2018. The admission rate of dengue cases showed a steep rise in 2016, followed by gradual decline in respective years. However, swine flu admission rate showed a zigzag pattern over the past 5 years. Conclusion: The review of hospital records provided information regarding the overall burden and pattern of admissions in the IDs hospital.
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Cryptococcus laurentii: An unusual cause for atypical pneumonia in hematological malignancy p. 45
Sunita Kabi, Swati Jain, Bichitrananda Swain, Nandita Sharma
Cryptococcus laurentii, one of the nonneoformans Cryptococcus is a known biopesticide to control fruit rot, previously considered to be nonpathogenic to humans, is now have been reported as a cause of opportunistic infections. Here, we present a case of pulmonary cryptococcosis due to C. laurentii in a patient with chronic lymphocytic leukemia and prolymphocytic leukemia. Sputum microscopy showed Gram-positive spherical capsulated budding yeast cells, culture of which revealed it as C. laurentii. The patient was promptly put on fluconazole, but he died on the subsequent day after initiation of therapy. A high index of suspicion and improvement of techniques of culture and identification is essential for early diagnosis and treatment of unusual fungal infections.
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Neurothekeoma of the scalp in a child: A rare case p. 48
Aditya Pratap Singh, Maryem Ansari, Ramesh Tanger, Arun Kumar Gupta
Neurothekeoma (NT) is a rare, benign tumor that is derived from peripheral nerve sheath cells. There are less than 300 cases reported in the literature to date. Historically, this tumor has been subclassified as myxoid (classic), mixed, or the cellular type, depending on the amount of myxoid stroma and cellularity. Here, we present a case of NT (mixed type) of the scalp in a 3-year-old female child. The tumor was completely excised. No recurrence was detected in the past 3 months after the local excision.
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Medical jousting: Think well before speaking p. 50
Anjali Agrawal, Vijay Thawani
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Comment on: Knowledge and attitude regarding Zika virus disease among junior residents of a tertiary care hospital in Delhi, India p. 52
Hadi Esmaily, Elmira Niknami, Ali Saffaei
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Envisaging the burnout conundrum in health-Care settings under the lens of organizational behavior and professional self-concept p. 53
V Dinesh Kumar, S S S N Rajasekhar
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Illness divinized p. 55
Mayank Mishra
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Stress!! p. 56
OP Gupta
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The Nobel prize in physiology or medicine 2019 p. 57
OP Gupta
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