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   Table of Contents - Current issue
April-June 2021
Volume 8 | Issue 2
Page Nos. 65-138

Online since Wednesday, October 27, 2021

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Case review of ocular scedosporiosis p. 65
Alok Agrawal, Mainak Raychaudhuri
Fungal keratitis is one of the leading cause of corneal blindness especially in developing countries like India. It requires prompt diagnosis and vigorous management as early as possible. Any delay in the initial period can have severe consequences on the quality of life of the patient. This often happens in a patient who is immunocompromised and is therefore slow to respond to treatment. However, as evident from this article, even an immunocompetent patient can prove to be a challenging case, especially if the causative organism is a rare filamentous fungi like Scedosporium apeospermum.
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Factors influencing prevention and control of malaria among pregnant teenagers in rural parts of Delta State, Nigeria p. 67
Rolle Remi Ahuru, Clement Atewe Ighodaro
This study was conducted to assess the factors associated with malaria prevention and control among pregnant teenagers in four Primary Healthcare Centers in rural Delta State. A facility-based cross-sectional study was conducted among 427 pregnant teenagers in the rural part of Delta State, and data were collected using a self-administered questionnaire prepared in English and analyzed using STATA 13.0. Descriptive statistics and binary logistic regression analysis were conducted to determine the prevalence of malaria adherence and its predictors among pregnant teenagers. The results revealed that 50.1% reported sleeping under insecticide-treated nets (ITNs), 49.2% reported using indoor residual spray (IRS), and 38.4% intermittently treat malaria in pregnancy (IPTp). Women who reported secondary educational qualification were approximately three times (adjusted odd ratio [aOR]: 2.72, P =0.01), five times (aOR: 5.27, P <0.001) and nine times (aOR: 9.23, P <0.001) significantly and respectively more likely to sleep under ITNs, use IRS and IPTp. Those who reported tertiary education (aOR: 6.16, P =0.04) were approximately six times significantly more likely to IPTp. Unemployed women (aOR: 0.46, P =0.02) were 54% significantly less likely to intermittently treating malaria in pregnancy. The findings suggest that malaria prevention programs and intervention strategists should consider the socioeconomic conditions of poor rural teenagers, promote female literacy, and target women with several births.
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Mass screening of COVID-19 cases by sputum testing: An Indian perspective p. 76
Sheikh Mohd Saleem, Nishantadeb Ghatak, Sudip Bhattacharya
SARS CoV 2 virus is detected in the respiratory tract by using nasal/oropharyngeal and nasal mid-turbinate swabs, nasopharyngeal wash and aspirate, and an oral aspirate. The anterior nares are the most common place to collect samples due to its ease and little invasiveness. Sample collection requires experienced hands, and if the appropriate technique isn't followed, it might lead to false negative results and alter the final conclusion. Because of its size and robustness, India's healthcare system has over 700 districts each running National Tuberculosis Elimination Program (NTEP) and experts in India have proposed modifying the CBNAAT machines used in NTEP program for COVID 19 testing by utilizing a new cartridge. After a second wave of COVID-19 cases, the number of cases in India is on the rise again. When dealing with a highly contagious disease, healthcare professionals are constrained by a lack of personal protective equipment, logistics, and infrastructure. The nasopharyngeal specimen and the procedure involved, make it a more difficult and riskier affair for healthcare practitioners to perform. If COVID-19 is combated with the NTEP's current infrastructure, human resources, and logistics, we believe that early detection of cases and overall containment will be maximized. Sputum samples can be self-collected in small plastic containers and sent to the nearest tuberculosis unit for CBNAAT analysis instead of using the professional technique of collecting nasopharyngeal swabs in Viral Transport Media. Sputum sample collection is a simple operation. Be it in urban tertiary care facilities or a rural subcentre. To collect sputum, healthcare staff can simply assist. In the current phase of the pandemic in India, where the majority of COVID-19 infections are asymptomatic, mass screening at the community level using effective testing specimens and methodologies becomes critical and the only choice. It would make sense to collect COVID-19 samples at the community level based on the scientific evidence in such a scenario, especially for a country with a population of over 1.3 billion people.
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Evaluation of the pediatric antimalarial prescriptions in a teaching hospital in Southeastern Nigeria p. 79
Adaobi Uchenna Mosanya
Background: Malaria in Nigeria with the highest morbidity and mortality in children between 6 months and 5 years continues to be a disease burden. In line with the World Health Organization recommendation of diagnosis in all ages before treatment, Nigeria provided guidelines on parasite-based diagnosis. Therefore, in order to achieve its preelimination and the reduction of mortality caused by it to zero by 2020, it is necessary to assess the compliance of the prescribers to the guidelines. Objectives: The objectives of this study were to determine the cases who were diagnosed based on positive malaria parasite test and the level of compliance of the prescribers to the National Malaria Treatment Guidelines. Methods: A total of 3034 prescriptions of antimalarial drugs were collected between 2003 and 2011 in the Outpatient Department of the Pediatric Clinic. Data were analyzed using Microsoft Excel and SPSS V.20.0 and grouped into two: prepolicy (2003–2005) and postpolicy (2006–2011) periods. Descriptive and inferential statistics were used at P < 0.05 level of significance. Results: The study revealed that diagnosis based on positive malaria parasite test was 4.8% of 2765 patients. There was a noticeable increase in the prescription of artemisinin combination therapy in the postpolicy period (32.6%), but the compliance to the Antimalarial Treatment Guideline was low (23.8%). Conclusion: There was a high incidence of empirical diagnoses of malaria and treatment. Many of the artemisinin-based combination therapies prescribed were not recommended.
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Cognitive impairment in patients with atrial fibrillation without stroke p. 84
Vineeth Jaison, Sarah Sharma, Himani Khatter, Rajneesh Calton, Jeyaraj Durai Pandian, Mahesh Pundlik Kate
Background: Vascular dementia is the second leading cause of dementia worldwide; however, the causation is multifactorial and may be preventable. There is increasing evidence that atrial fibrillation (AF) is independently correlated with cognitive decline. Assessing cognition in an outpatient setting is challenging. Gait speed may be able to transcend language in assessing cognition. We aim to assess cognitive impairment in patients with AF without known history of stroke with gait speed. Methods: This was a prospective, observational study of patients attending cardiology outpatient department. Patients were screened for a history of valvular or nonvalvular AF. Controls were patients without AF. Patients underwent structured interview, Montreal cognitive assessment (MoCA), and gait velocity assessment. Gait velocity and MoCA scores were compared in control and cases using Student's t-test. Results: A total of 189 patients were consented; 88 cases with AF and 101 controls. Mean ± standard deviation age was 60 ± 12 years. The median (interquartile range) gait velocity in patients with AF and nonAF was similar (0.80 [0.65–0.93] m/s vs. 0.80 [0.65–0.93] m/s, P = 0.708). The mean MoCA scores in patients with AF and without AF were also similar (17.38 ± 5.66 vs. 18.36 ± 5.30, P = 0.229). A cutoff value of <0.80 m/s had sensitivity of 66% and specificity of 61.4% to diagnose dementia. Conclusion: There is a high occurrence of cognitive deficits in patients with and without AF visiting a cardiology outpatient clinic. Future studies are needed to target this group of the patient to reduce the burden of vascular dementia.
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Association of demographic characteristics to depression, anxiety, and stress among diabetics: A cross-sectional report from resource-limited settings of South India p. 89
Vigneshwaran Easwaran, Sai Varun Kudumula Mulammagari, Chaitanyakumar Lakkepogu, Rajarajeshwari Byram, Sultan Mohammed Alshahrani, Sirajudeen Shaik Alavudeen, Noohu Abdulla Khan
Background: In India, there is a scarcity of epidemiological data related to risk factors and prevalence of depression, anxiety, and stress (DAS) among diabetics. Therefore, their estimation may provide data for an effective management of these disorders in diabetic patients. Aim: The current study was undertaken to analyze the effect of sociodemographic characteristics toward DAS symptoms and to estimate the prevalence of DAS among diabetics. Materials and Methods: It was a cross-sectional study conducted among diabetics at the resource-limited settings of South India. Non probabilistic convenient sampling was used for recruitment fo study subjects. DAS scale 21 questionnaire is a validated self-report questionnaire designed to measure the severity of a range of symptoms for DAS. The patients with established psychiatric disorders were excluded from the study. Results: Overall, the prevalence of DAS symptoms was 57.5%, 55.9%, and 44.9%, respectively, and which ranges from mild to extremely severe. Gender plays a major role in increasing the prevalence of depressive and stress symptoms. The elderly age group was found to have more prevalence of all these three symptoms than younger age. Conclusions: The study showed that the prevalence of DAS symptoms was high. However, in our study, these symptoms are poorly associated to demographic characteristics. We recommend to screen all the diabetic patients for DAS symptoms.
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A study to assess the effect of supplementary nutrition on nutritional status of preschool children in selected Anganwadis, Bengaluru South p. 95
Sambhu Viswanath, PM Thressiamma, MB Sunil
Background of the Study: Protein energy malnutrition has been identified as a major health and nutrition problem in India. Hence, the investigator felt the need to evaluate the effectiveness of nutritional supplement among preschool children in selected Anganwadis, Bengaluru. Materials and Methods: Using purposive sampling technique, a total of 60 samples were selected with 30 in experimental and 30 in control group. Quasi-experimental design with pretest nutritional assessment and posttest nutritional assessment with control design is used. Results: The prereading mean weight score was 11.49 and the postreading score increased to 12.28. Similarly, the prereading mean score of height 94.32 increased to a mean score of 94.52 in posttest. While considering the head circumference of the preschool children, the pretest mean score of 47.82 changed to 48.03 during the posttest. During the pretest, the mean reading of mid-arm circumference was 14.67, which then increased to a mean value of 14.80 during the posttest. The chest circumference of the children was 50.85 during the pretest which then increased to 51.01 during the posttest. Thus, an overall improvement had occurred in the anthropometric measurements of preschool children even though statistically, it is not significant. Conclusion: The overall findings of the study revealed that there was a marked improvement in the anthropometric measurements of preschool children. Hence, it can be concluded that the nutritional supplement was effective in improving the nutritional status of the children.
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Nutritional status of children under five years of age and factors associated in rural areas of Sana'a Governorate, Yemen p. 102
Gawad M A. Alwabr, Nwbal M A. Alwabr
Background: The nutritional status of children determines their health, physical development, educational performance, and progress in life. This study aimed to assess the nutritional status and associated factors of children under 5 years of age in rural areas in Sana'a Governorate, Yemen. Materials and Methods: A descriptive cross-sectional study was conducted at five rural health centers of Sana'a Governorate, from March to May 2018. A convenience sampling method was used in the selection of 150 mothers and their children under five. A semi-structured questionnaire was used in data collection. According to WHO standards, the middle-upper arm circumference tool was used to measure the circumference of the upper part of the arm of the study children. Results: This study results showed that of all the children, 38.7% had Mild Malnutrition, 34% had Moderate Malnutrition, 6.7% had Severe Malnutrition, and 20.7% were normal. Majority of the participants' mothers (81.3%) were not knowledgeable about malnutrition causes. Place of delivery, mothers' education, fathers' education, age of mothers in the first pregnancy, numbers of all children per household, a child's weight at birth, and age of the child at weaning, were associated with the nutritional status of children under 5 years of age (P < 0.05). Conclusions: Despite the efforts of redressing child malnutrition issues in Yemen, the proportion of malnutrition among children under the age of five still high. Multiple intervention strategies based on risk factors can reduce early malnutrition of the children under the age of five.
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Incidence of new-onset diabetes among sudanese renal transplant patients using different immunosuppressive regimens: A retrospective study Highly accessed article p. 110
Alaa Mohammedazeem Elzain, Safaa Badi, Bashir Alsiddig Yousef, Habab Khalid Elkheir
Background: New onset diabetes after renal transplant (NODAT) is a serious complication of therapy with immunosuppressive drugs. The aim of this study was to estimate the incidence of NODAT and its association with immunosuppressant regimens within 6 months of the administration. Methodology: A descriptive retrospective case finding hospital-based study, conducted in the department of nephrology at Ahmed Gasim Hospital from January to September 2017, on patients who underwent renal transplantation between June 2015 and June 2016. The data were collected using a structured checklist. The collected data were analyzed by the Statistical Package for Social Sciences (SPSS). Results: A total of 110 patients were included, the majority of studied patients were males (71.8%) and in the age group of 20–40 years (50.9%). The most commonly prescribed immunosuppressant regimen was regimen, which consists of methylprednisolone as induction therapy and tacrolimus + azathioprine + prednisolone as maintenance therapy. Regarding the adverse effects, 11 (10%) of them developed NODAT throughout 6 months after transplantation. However, no significant association was found between the postulated risk factors and the incidence of NODAT. Conclusion: The incidence of NODAT was 10% throughout 6 months after transplantation. Correlations between sociodemographic characteristics, immunosuppressant regimens, episodes of rejection with the incidence of NODAT were found statistically insignificant.
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Use of flaps in orthopedics in a peripheral trauma center in Nepal without plastic surgery services p. 117
Bhim Bahadur Shreemal, Tul Bahadur Pun, Dipak Maharjan, Devendra Singh Bhat
Background: Soft tissue cover after surgical debridement, skeletal stabilization is an integral part of optimal management of high-velocity orthopedic injuries and orthopedic infections which is preferably done in collaboration with plastic surgeons. In our peripheral hospital, since plastic surgery service is not available, it has been our practice as orthopedic surgeons to be involved in the comprehensive surgical care of such patients including flap cover of the resulting soft-tissue defect. We reviewed the results of our flaps from June 2013 to May 2015 which were exclusively done by orthopedic surgeons. Materials and Methods: All patients from June 2013 to May 2015 with an open fracture or orthopedic infections who underwent flap cover of any kind in both the upper and lower limbs were retrospectively reviewed. Results: We had thirty-eight flaps in 36 patients. Two were lost to follow-up. There were eight (22.22%) upper limb flaps and 28 (77.77%) lower limb flaps. Average follow-up was 3 months (6 weeks–12 months). The average age was 35 years (17 years–65 years). Ten (27.7%) of the patients had flap done for infection and the rest 26 (72.2%) for an open fracture. The dimension of the flap ranged from 1 cm × 1 cm to 15 cm × 16 cm. Thirty-one out of thirty-six (83.33%) of the flaps healed primarily. Six (16.66%) patients had minor complications. There was no total flap loss. Conclusion: Comprehensive care of soft-tissue defects by orthopedic surgeons themselves seem to be a viable option with good outcome and acceptable complications in orthopedic trauma and infections when plastic surgery service in not available.
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Predictors of in-hospital mortality in patients admitted with congestive Heart failure (HF) in a general medical ward – A case-control study from a tertiary care centre in South India p. 125
Faith Mariam John, Anisha Joy, Nevine Joseph Nellimala, K Muruga Bharathy, Turaka Vijay Prakash, Kevin John John, Alice Joan Mathuram, Sowmya Sathyendra, OC Abraham, I Ramya, Visalakshi Jayaseelan, Thambu David Sudarsanam
Background and Objectives: Studies around the world have shown that incidence of HF is increasing with the highest risk of mortality during their first admission and in the subsequent 1 year. Only a few Indian studies had looked at the predictors of in-hospital mortality in patients admitted with HF in patients admitted in medical wards. We have done a case control study to determine the risk factors for in-hospital mortality, in patients admitted with HF, in general medical ward, in a tertiary care centre in south India. Methods: We collected demographic data, clinical details and outcome data from case records. We performed a univariate analysis comparing those who died as compared to those who did not. Factors that were significant in the above, were entered into a logistic regression analysis to identify factors that independently predicted poor outcomes. Results: The in-hospital mortality rate in patients admitted with HF was 12.19%. On multivariate analysis, Systolic blood pressure < 115 mmHg {OR – 2.82, CI (1.29 – 6.19)}, serum lactate > 2 mmol/l {OR-2.61, CI (1.16 – 5.87)}, and GCS < 15 {OR 6.64, CI (2.26 – 19.51)} were statistically significant. Conclusion: Our study has shown that, in patients admitted with HF in general medical ward, at admission, low systolic blood pressure, high serum lactates, low GCS were predictors of in-hospital mortality.
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Goldenhar syndrome with new oral findings! p. 131
Vela D Desai
Goldenhar syndrome (GS) is a condition with a multitude of abnormalities, classically involving ocular and ear defects, hemifacial microsomia, and vertebral anomalies, which may also be associated with cardiovascular and renal malformations. It is a rare congenital anomaly of unclear etiology. The purpose of reporting this case of a 16-year-old boy with GS is, to update, the existing literature of new oral findings observed.
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Placement of tunneled peripherally inserted central catheter for long-term chemotherapy in femoral vein in a patient with major vessel thrombosis of upper extremity p. 134
Srinivasa Shyam Prasad Mantha, PH Sai Kaushik, Abhijit S Nair, Basanth Kumar Rayani
Peripherally inserted central catheter (PICC) placement can be extremely challenging and difficult in certain situations. In this case report, we have described PICC placement in right femoral vein in a patient who had thrombosis of arm veins and great veins in neck. We have described a unique way of tunneling the catheter in lower abdominal wall so as to use it for long term and avoid infections which is common with groin lines.
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Hormone secreting juvenile granulosa cell tumor of the ovary in an infant presenting with massive ascites and precocious pseudopuberty p. 136
Minakshi Bhosale, Jyoti Kudrimoti, Deepak Dangmali
Juvenile granulosa cell tumors (JGCTs), account for 4–5% of GCTs, the rare sex cord stromal tumors. Presentation of JGCTs in infants is even rarer. We present case of a 3-month-old female infant with abdominal distension, feeding intolerance and fever of 10 days' duration. The child had gross abdominal distension causing visible respiratory distress. She also had signs of isosexual precocious puberty. Radiological evaluation was suggestive of left ovarian tumor. Left oophorectomy with preservation of the fallopian tube was done after hemodynamic stabilization. Histopathology evaluation of the tumor was suggestive of JGCT, which was confirmed on immunohistochemical evaluation. On 1 year follow-up, the child is stable, has achieved age-appropriate milestones and is tumor-free. Parents have been explained importance of regular follow-up to detect tumor recurrence. This is probably the youngest case of JGCT presenting with precocious puberty reported in literature so far.
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