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   Table of Contents - Current issue
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July-December 2020
Volume 25 | Issue 2
Page Nos. 59-120

Online since Tuesday, December 15, 2020

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EDITORIAL  

Empowered rural communities: The key to India's response to COVID-19 pandemic p. 59
Subodh Sharan Gupta, Pranali Kothekar
DOI:10.4103/jmgims.jmgims_125_20  
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REVIEW ARTICLES Top

Sarcopenia: A review p. 62
OP Gupta
DOI:10.4103/jmgims.jmgims_80_20  
Sarcopenia is the process of loss of skeletal muscle mass. It has recently been recognized as a separate entity, and there is very little awareness about it among health professionals. Sarcopenia is a geriatric condition where there is an age-related primary loss of muscle mass, although it has now been recognized to begin early in life. In general, loss of muscle mass occurs secondary to chronic illness, malignancy, or drugs, particularly long-term steroid therapy and cytotoxic drugs. Aging itself may cause sarcopenia, especially in inactive individuals who have a sedentary lifestyle. There is a decrease in muscle mass with increase in intra- and intermuscular adipose tissue. Besides epigenetic factors, malnutrition, chronic inflammation (raised cytokine levels of interleukin (IL)-1, IL-6, and tumor necrosis factor-alpha), and changes at hormonal and mitochondrial level are responsible for the poor muscle growth and loss of muscle mass and strength and thereby affect the performance of activities of daily living. Diagnosis of sarcopenia can be made by simple clinical tests which detect loss of muscle mass and strength. Loss of muscle mass can be confirmed with the help of computed tomography, magnetic resonance imaging, and ultrasonography. Exercise and improvement of nutrition are the mainstays of treatment. So far, no specific drug is available for the treatment of sarcopenia, though some age-old drugs such as metformin and anabolic steroids have been tried with variable results. Some new molecules have shown positive results in experimental animals and are in various phases of clinical trials.
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Dysbiosis of gut microbiota and human diseases p. 66
Sangeeta Huidrom, Mirza Atif Beg
DOI:10.4103/jmgims.jmgims_59_19  
Gut microbiota of humans harbour a complex and dynamic community of more than 100 trillion beneficial microbes. Recent advances in tools and techniques of microbial analysis have made it possible to understand better the important role played by gut microbiota in the human body. The composition of gut microbiota depends on many factors, such as the mode of delivery of the baby, environmental conditions, antibiotic usage, age, and diet. Homeostasis of gut microbiota is important for maintaining good health as it influences human nutrition, metabolism, and immune function, while dysbiosis of the gut microbiota is associated with various gastrointestinal and metabolic disorders, such as inflammatory bowel disease, obesity, type 2 diabetes, colon cancer, and dysregulation of the immune system. Clinical evidences have shown that diseases caused by imbalance gut microbiota can be treated by probiotics. However, more research work is required to get insightful knowledge of what kind of particular microbes and underlying molecular mechanisms are responsible for a particular disease.
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Functional foods for mental health promotion p. 72
Soumam Dutta, Sohini Roy, Sanchari Roy
DOI:10.4103/jmgims.jmgims_15_20  
Mental health problems and morbidities are increasing day by day. The etiology of mental health disorders is extremely complex and encompasses a range of genetic, dietary, emotional, and social as well as lifestyle factors. Finding adequate therapeutic and preventive strategies for mental health promotion is a great challenge. India is a country which is famous for its flora and fauna, many of which possess functional and medicinal properties. This article summarizes the mental health role of some selected functional foods of Indian origin, namely, brahmi (Bacopa monnieri), ashwagandha (Withania somnifera), turmeric (Curcuma longa), garlic (Allium sativum), and pumpkin seeds (Cucurbita maxima). Relevant article searches were conducted in PubMed, Google Scholar, and Google to identify the scientific articles highlighting the role of the functional foods on various mental health problems such as neurodegeneration, Alzheimer's disease, Parkinson's disease, depression, epilepsy, stress, and anxiety. The eligible articles were reviewed to gather information. These functional foods were found to be highly beneficial in treating and preventing mental health disorders mainly due to their antioxidant and anti-inflammatory properties as well as their ability to prevent mitochondrial dysfunction and degrade abnormal protein aggregates. These functional foods were also found to be effective in the improvement of the activities of various neurotransmitters such as acetylcholine and monoamines. These foods can be incorporated into the diet as well as can be used to develop drugs and nutraceuticals for treating various psychiatric problems.
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ORIGINAL ARTICLES Top

A low cost ingenious approach for ultraviolet decontamination of N95 filtering face-piece respirators to deal with dwindling supply during the COVID-19 pandemic p. 80
Anjali Patond, Rahul Narang
DOI:10.4103/jmgims.jmgims_48_20  
Introduction: COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus-2 is rapidly evolving and hospitals are facing the issue of shortage of personal protective equipment (PPE) due to stringent requirements of PPE use. For reuse of N95 filtering face-piece respirators (N95FFR), we prepared an ingenious cabinet with ultraviolet light C (UV-C) using scarce material available during the lockdown period. Materials and Methods: Since like many other microbiology laboratories in medical colleges, we did not have access to viruses, we could not test our product with them. We thus tested the efficacy of the cabinet to decontaminate material using 0.5 McFarland standard broth of Escherichia coli 25922. The broth was exposed to UV-C inside the cabinet for 15 and 30 minutes in Petri dishes, with and without lids. The broth was subcultured on nutrient agar plates, both pre and post exposure. We also could not test integrity and static charge of the respirators; we relied on CDC data on the same. Results: It was observed that there was at least 4 log reduction (99.99%) in the number of viable E. coli on exposure to UV-C for 15 as well as 30 minutes. The plates with glass lids on did not show any reduction in number of viable bacilli. The reduction in number of E. coli was taken as surrogate marker for the reduction of ssRNA viruses. Conclusions: UV-C inside an ingeniously made cabinet can be used to decontaminate N95 FFR in exceptional circumstances of reduced supply under lockdown conditions of a pandemic.
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Prediction of lipohypertrophy in patients with diabetes mellitus p. 86
V Brijeetha, Jonita Evett Fernandes, Jyothi Idiculla
DOI:10.4103/jmgims.jmgims_58_19  
Introduction: Lipohypertrophy (LH) may result in variable absorption of insulin and affect glycemic control. Objectives: This study aimed to study the risk factors and prevalence of lipohypertrophy in diabetic patients at a tertiary hospital in South India. Methodology: 206 patients with diabetes mellitus aged over 18 years of age, on insulin therapy for over two years, were included in this study conducted at St Johns Medical Hospital to explore the prevalence and risk factors for development of lipohypertrophy. Demographics, duration of diabetes and insulin therapy, type of needles used, times of reuse, injection technique was recorded. The injection sites were inspected meticulously for the presence of lipohypertrophy. Results: 66 patients (32%) were found to have LH of which 62 had Type 2 diabetes and 4 had Type 1 diabetes. The median duration of diabetes was 15 years (IQR 10-20) and was higher in the group with LH (P=0.000). The duration of insulin therapy was 10 years (IQR 5-10.5) and was significantly higher in the group with LH (P=0.000). The commonest site for insulin injection was the abdomen and it was associated with LH (P=0.000).Patients reusing the needles over 6 times and those who failed to rotate injection sites had the highest frequency of LH(P=0.000). Conclusions: Patients on long term insulin should be advised against the reuse of needles to save on cost of therapy in view of increased risk of LH and glycemic variability. Physicians must reinforce proper insulin injection technique periodically and document lipohypertrophy if present.
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Central corneal thickness: Important considerate in ophthalmic clinic p. 90
Sneha Thakur, Ajay Kumar Saxena, Archna Bhatnagar
DOI:10.4103/jmgims.jmgims_18_18  
Aim: The aim of this study was to evaluate the relationship of central corneal thickness (CCT) with age, sex, refractive status, and keratometry (KM). Materials and Methods: In our cross-sectional study, 1000 eyes of 500 patients from the outpatient department were randomly selected between July 2014 and December 2015. CCT was measured with a Humphrey ultrasonic pachymeter. Horizontal and vertical curvatures of the cornea were measured with a Bausch and Lomb keratometer, and its mean was calculated. Refractive state was measured with a Priestley-Smith retinoscope and converted to spherical equivalent (SE). The patients were divided into three age groups (Group A [16–30 years], Group B [31–45 years], and Group C [46–60 years]), and the data were analyzed statistically by the Statistical Package for the Social Sciences programme. Results: The mean SE, KM, and CCT of the patients under the study were(-) 0.47 ± 2.26, 43.79 ± 1.18D, and 528.41 ± 19.1 μm. The mean CCT was higher in age Group C (46–60 years) than other groups (P = 0.008), but we found that an increase in age has no impact on CCT after regression analysis. CCT was not affected by sex (p = 0.168). The mean CCT for myopic patients was 522.87 ± 18.03 μm, which was less compared to 536.39 ± 17.753 μm in hypermetropic patients (p ≤ 0.001). Positive correlation was found between CCT and SE (r = 0.520,P≤ 0.001). KM showed negative correlation with CCT (r = −0.288,p≤ 0.001). Conclusion: From our study, we concluded that CCT was related to age, refractive status, and KM, but not to sex.
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Why do orthopedic implants break?: A retrospective analysis of implant failures at a rural tertiary care centre in central India p. 95
Rohan R Patil, Chandrashekhar M Badole, Girish B Mote, Kiran N Wandile
DOI:10.4103/jmgims.jmgims_29_19  
Background: The AO Foundation's Association for the Study of Internal Fixation has advocated rigid fixation with implants in the form of plates and screws. Focus is on development of implants which are stronger, more acceptable to the body, cheaper, and durable. Aim: The aim of this study was to find the factors responsible for implant breakage. Materials and Methods: We have retrospectively analyzed the data from January 2008 to December 2018 (10 years). Information on sociodemographic characteristics, clinical features, and radiographic features was retrieved from the hospital information system. Data were entered and analyzed with Epi Info software. Results: Of the 37 patients, there were 33 (89.2%) males and four (10.8%) females in the age group of 17-95 years. The most common site for implant breaks was observed to be the shaft of the femur (40.5%), and the most common type of implants which broke were locking intramedullary nails (62.1%). Conclusion: The factors responsible for breakage of implants were observed to be: retrauma, failure of compliance with advice about ambulation, absence of union at fracture sites, and persistent infection. Out study shows the importance of educating patients properly about physiotherapy and rehabilitation protocols.
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Accuracy of magnetic resonance imaging in assessing types of degeneration in leiomyomas p. 99
Sheema Posh, Suhail Rafiq, Farzana Manzoor, Obaid Ashraf, Musaib Ahmad
DOI:10.4103/jmgims.jmgims_40_20  
Background: Leiomyomas are the most common benign uterine neoplasms arising from smooth muscle cells. Magnetic resonance (MR) imaging is the most accurate imaging technique for detecting and localizing leiomyomas. As leimyomas grow, they may outgrow their blood supply resulting in various types of degeneration such as myxoid, hyaline, cystic, red, and calcification. Degenerated leiomyomas have variable appearances on T2-weighted images and contrast-enhanced images. Materials and Methods: This was a retrospective hospital-based study done in Government Medical College, Srinagar, from January 2018 to December 2019. The study included 78 patients with more than 2 cm pathologically proven fibroids who underwent myomectomy or hysterectomy and preoperative MR imaging (MRI). We assessed the accuracy of MR for picking degeneration in fibroids. Aim and Objective: The aim and objective of this study is to determine the sensitivity, specificity, positive, and negative predictive value of MRI in assessing degeneration in uterine fibroids. Results: The sensitivity, specificity, positive and negative predictive values of MRI in assessing degeneration in uterine fibroids were 60%, 93.7%, 85.7%, and 78.9% respectively. Menorrhagia followed by dysmenorrhea was the most common presenting symptom. Conclusion: MRI has average sensitivity and very good specificity for picking fibroid degenerations. MRI has high accuracy for picking up myxoid, cystic, and red degeneration.
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The association between chronic kidney disease, waist circumference and body mass index: A case-control study from a tertiary hospital of West Bengal, India p. 103
Anirban Ghosh, Somak Kumar Das
DOI:10.4103/jmgims.jmgims_64_19  
Introduction: In this hospital-based study, we investigated the association between chronic kidney disease (CKD) and two globally accepted obesity parameters – waist circumference (WC) and body mass index (BMI). Aims: To investigate the association between CKD with BMI and WC. Materials and Methods: We included 416 consecutive CKD patients (age >20 years, calculated glomerular filtration rate <60 ml/min/1.73 m2) as the case group and 408 consecutive age- and sex-matched non-CKD patients as the control group for our study. after obtaining consent, all groups were tested for WC and BMI. Results: Of 416 cases, the prevalence of high WC according to the International Diabetes Federation (IDF) criteria was 37.5% and of obesity according to the Indian BMI scale was 38.46%. When compared with the control group, we found that WC (p < 0.0001, odds ratio [OR] 2.182, 95% confidence interval [CI] 1.099–1.852) and BMI (p = 0.006, OR 3.125, 95% CI 1.625–3.125) were significantly high in the CKD group. Conclusion: The parameters of obesity were found to be significantly associated with the non-edematous CKD group.
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CASE REPORTS Top

Cutaneous dermatophyte invasion below the stratum corneum in an immunocompetent patient: To blame mixed creams or not? p. 107
Hari S Pathave, Atul M Dongre, Vivek V Nikam
DOI:10.4103/jmgims.jmgims_19_19  
Dermatophytes are pathogenic fungi that infect human skin, nails, and hair. Dermatophytes very rarely invade the epidermis below the stratum corneum in an immunocompetent host. Herein, we report a case of invasive cutaneous dermatophytosis in a 30-year-old immunocompetent male who had a history of intermittent mixed cream application on the lesion. Biopsy from the plaque showed neutrophilic spongiosis with superficial perivascular infiltrate of neutrophils, eosinophils, and lymphocytes. On periodic acid–Schiff staining, multiple branched septate hyphae in the stratum corneum were seen. Some of them were seen invading the stratum granulosum and upper spinous layer. On culture, Trichophyton schoenleinii species was isolated.
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Branch retinal artery occlusion in a young healthy patient: Embolism as a rare cause p. 110
Jyoti Jain, Shashank Banait, Tanvi Banait
DOI:10.4103/jmgims.jmgims_70_19  
Branch retinal artery occlusion (BRAO) is an acute, painless, vision threatening, ocular emergency among people older than 60 years having cardiovascular disease. Here, we present a case of BRAO which occurred due to embolism as a rare etiology in an otherwise healthy young Asian male without any systemic or ocular disorders. The patient was treated as an ocular emergency with improved vision and retinal perfusion. The patient did not complain of recurrence of symptoms in the 3 months after the treatment.
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Segmental neurofibromatosis: A report of a rare case p. 113
Pratiksha Sonkusale, Sumit Kar, Pooja Bonde, Komal Ramteke
DOI:10.4103/jmgims.jmgims_63_17  
Neurofibromatosis (NF) is a genetic disorder with an autosomal-dominant inheritance mainly affecting the growth of the cells of the neural tissues. Segmental NF (SNF), a rare variant of NF (NF type V), is characterized by café-au-lait macules and freckles or neurofibromas limited to one segment or one region of the body. A 26-year-old married female presented with asymptomatic café-au-lait macules and freckles involving the left cervical and thoracic region. The lesions did not cross the midline. Family history was not positive. There was no history of consanguineous marriage. There was no systemic involvement. We report this case as a rare entity of NF along with multidermatomal involvement.
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Siamese twins: Thoracopagus – A rare congenital anomaly p. 116
Insha Khan, Mohd Ilyas, Shariq Ahmad Shah, Cimona Lyn Saldanha
DOI:10.4103/jmgims.jmgims_60_17  
A case report of conjoined twins (thoracopagus-conjoined neck, thorax, and upper abdomen) diagnosed by routine ultrasonography in a 26-year-old G2 P1 pregnant female at 19 weeks of gestation is discussed. The pregnancy was terminated at this gestation with explained prognosis to the patient and consent of the family.
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LETTER TO EDITOR Top

Assessment of the national capacity and preparedness to respond to the coronavirus disease 2019 outbreak p. 119
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jmgims.jmgims_19_20  
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