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Volume 6, Number 2, April-June 2019
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From the Editor's Desk

National Medical Commission (NMC) Bill, India, 2019: Long-awaited Change with a Mixed Response

[Year:2019] [Month:April-June] [Volume:6] [Number:2] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/mgm-6-2-iv  |  Open Access |  How to cite  | 

211

Original Article

Kanishka Kumar, Prashant Upadhyay, Rajendra Jha, Sushil Kacchhap

Predictors of Mortality in Vasculotoxic and Neurotoxic Snakebite Patients in a Tertiary Care Institute in Jharkhand, India

[Year:2019] [Month:April-June] [Volume:6] [Number:2] [Pages:5] [Pages No:53 - 57]

Keywords: Emergency medicine, Snakebite, Venom

   DOI: 10.5005/jp-journals-10036-1233  |  Open Access |  How to cite  | 

Abstract

Introduction: The paper presents a study carried out in vasculotoxic and neurotoxic snakebite cases to find out the predictors of mortality in the state of Jharkhand. Materials and methods: An estimated 58 snakebite patients who fulfilled the inclusion criteria were enrolled into the study. The clinical parameters and epidemiological data were noted during admission. Patients were followed up during their stay in the hospital for the progress of the symptoms and the treatment effects. Data obtained were analyzed using SPSS and Microsoft Excel. Results: There was a significant positive association between the occurrence of GI bleed/epistaxis, DIC, or shock with an increased mortality in vasculotoxic snakebite cases. In the cases of neurotoxic snakebite, the occurrence of cardiac arrhythmias or respiratory failure was foretellers of an increased chance of mortality. Amongst the patients with vasculotoxic snakebite, local bleeding was present in all the patients and the infection was found in 94% of them. The complications included DIC in 36% of patients, GI bleed in 9%, epistaxis or gum bleed in 9%, shock in 21%, acute renal failure in 50%, and neurotoxic signs in 6% of the patients. In the neurotoxic subset, the most frequent symptoms were ptosis and blurring of vision, both in 100% of the cases, generalized paralysis in 79%, and local pain with swelling in 67%. Respiratory failure was seen in 50%, infection in 45%, cardiac arrhythmias in 33%, shock in 12%, and hepatotoxic features in 20%. Most of the patients required 30 vials or less of anti-snake venom serum (ASVS). Conclusion: GI bleed/epistaxis, DIC, or shock are positive predictors of mortality in vasculotoxic snakebite cases, while the occurrence of cardiac arrhythmias or respiratory failure are markers of a poor prognosis in neurotoxic snakebite cases.

280

Original Article

Nisha , Shridhar Dwivedi, Suresh K Gupta

Telemedicine as a Cost-effective Tool for Cardiovascular Diseases in Rural India: A Pilot Study in Delhi-NCR

[Year:2019] [Month:April-June] [Volume:6] [Number:2] [Pages:7] [Pages No:58 - 64]

Keywords: Cardiovascular diseases, Cost-of-illness, Diabetes, Rural health care, Telemedicine

   DOI: 10.5005/jp-journals-10036-1232  |  Open Access |  How to cite  | 

Abstract

Objective: Telemedicine is an economical tool for providing healthcare to remote areas. So far, not much is known about such endeavors targeting rural parts of India. The National Heart Institute, New Delhi joined hands with an NGO at Jewar, Greater Noida (predominantly a rural area) to provide teleconsultation to patients attending the Community Health Center. The present study aims to evaluate the direct and indirect cost of treating cardiovascular diseases using teleservices at Jewar. Materials and methods: It is a prospective, observational, and questionnaire-based study regarding the rural India. The demographic and complete clinical profile is noted in the telemedicine e-sanjeevani portal by a patient coordinator. A plausible clinical diagnosis is made at the NHI end after interacting with a patient on television and reviewing relevant investigations followed by instructions about drug treatment. At the end of the telesession, the direct cost (including medication, lab-investigation, consultation, transportation, any adverse drug reaction, internet, and setup cost) is calculated. The indirect medical cost was worked out using the human capital approaches such as the productivity loss of both the patient and attendants. Results: A total of 100 consecutive cardiovascular patients (including diabetes cases attending telemedicine sessions at NHI) were studied. There were 53 males and 47 females. The mean age of patients was found to be 55.29 ± 11.6 years (mean ± SD). The common cardiovascular diseases noted were found to be diabetes alone (48%), hypertension and diabetes (24%), diabetes and other comorbid conditions (9%), hypertension alone (9%), diabetes with two cardiovascular conditions (4%), diabetes, hypothyroidism and cardiovascular diseases (3%), hypertension associated with coronary artery disease (2%), and coronary artery disease alone (1%) in that order. The average treatment cost per patient (direct as well as indirect) for 10-month duration for diabetes alone was INR 6,302.22 (630.22/month), diabetes and hypertension together cost INR 10,546.71 (1,054.67/month), diabetes with other comorbid condition cost INR 12,086.62 (1,208.66/month), hypertension cost INR 15,505.63 (1,550.57/month), diabetes and other two cardiovascular diseases cost INR 8,376.91 (837.69/month), diabetes and hypothyroidism and cardiovascular diseases cost INR 13,899.80 (1,389.98/month), hypertension and coronary artery disease cost INR 8,844.33 (884.43/month), and coronary artery disease cost INR 2,125.34 (212.53/month). The overall total cost direct as well as indirect for this telemedicine project was around INR 9,09,095.63, including direct, indirect, set-up and internet charges for 10-months tenure. Conclusion: Telemedicine for rural people is a feasible proposition. Diabetes was found to be the most prevalent disease, thus possesses the maximum overall economic burden. The treatment for diabetes alone costs less than for diabetes associated with other comorbidities. Government telemedicine initiatives in India will further reduce the direct medical cost burden on rural patients substantially. Women empowerment is another important aspect of telemedicine. Adoption of this telemedicine model by health policymakers in India will lead to the better and affordable treatment to rural patients suffering from cardiovascular diseases.

289

Original Article

Suman Nandi, Kedar R Banerjee, Tanmoy Mitra

Investigation on Lipid Profile in Affective Disorder at a Hospital Clinic in Kolkata, West Bengal, India

[Year:2019] [Month:April-June] [Volume:6] [Number:2] [Pages:6] [Pages No:65 - 70]

Keywords: Cholesterol, Depression, High-density lipoprotein, Lipid profile, Low-density lipoproteins

   DOI: 10.5005/jp-journals-10036-1242  |  Open Access |  How to cite  | 

Abstract

Aim: Prior research has shown that particular types of mental states contribute to one's risk for depression, and that abnormal blood lipid levels can be associated with the manifestation of mood dysfunction. The role of lipid metabolism in the pathophysiology of depressive behavior has received particular attention recently. As depressive disorders vary in regard to etiology and diagnostic marker, the present study aimed to explore any lipid-profile disparity among the sample of depressive patient groups visiting a clinic for treatment. Materials and methods: The study group consisted of 80 patients diagnosed with three types of depressive disorders—endogenous, reactive, and dysthymic types. Groups were tried to match according to age, gender, and education. Results: The demographical difference between marital status and economic status revealed among patients. The present study reveals the difference among serum lipid levels among groups in regard to LDL cholesterol (lipoproteins of low-density). Further after adjusting the confounding factors such as age and BMI, the ratio of HDL (lipoproteins of high-density)/cholesterol and also the ratio of LDL/HDL were found to be significantly different among the groups. Conclusion: The present study shows the difference in lipid profile such as LDL cholesterol, HDL/cholesterol, and HDL/LDL ratios among psychogenic, reactive, and dysthymic groups. The psychogenic group reflects lower LDL and lower LDL/cholesterol, HDL/cholesterol ratios while compared to others. Clinical significance: This study highlights how the lipid profile can act as a biological marker in distinguishing depression subgroups and assessing associated cardiovascular risks.

234

Original Article

Sunanda Joshi, Nalini Mittal

Coinfection of HBV and HCV in HIV-positive Injecting Drug Users

[Year:2019] [Month:April-June] [Volume:6] [Number:2] [Pages:2] [Pages No:71 - 72]

Keywords: Hepatitis B virus, Hepatitis C virus, Human immunodeficiency virus, Injecting drug users

   DOI: 10.5005/jp-journals-10036-1237  |  Open Access |  How to cite  | 

Abstract

Introduction: Drug addicts represent a high-risk group for acquiring parenterally transmitted viral infections. It is very likely that an injecting drug user (IDU) infected with HIV will be infected with either HBV or HCV or both because of common high-risk behaviors. Materials and methods: A cross-sectional study was carried out in which a total of 229 blood samples were collected from IDUs. They were screened for HIV. Results and discussion: All HIV-positive patients were tested to observe whether a HBV or HCV infection (or both) is also present in the patients. A total of 22 patients were HIV-positive (9.6%). Of the 22 HIV-positive patients, 10 were positive for HCV (45.45%), 7 were positive for HBV (31.81%), and 2 (9%) were positive for all three. Conclusion: Prevention efforts such as vaccination of IDUs and maximum syringe distribution should be taken to avoid sharing of syringes. Screening of all HIV-positive IDUs for HBV and HCV should be made mandatory.

180

Original Article

Gita Negi, Rashi A Gulati, Rekha Bhandari, Vibha Gupta, Dushyant Gaur

Blood Donor Retention: Role of a Donor Satisfaction Survey

[Year:2019] [Month:April-June] [Volume:6] [Number:2] [Pages:3] [Pages No:73 - 75]

Keywords: Blood donor retention, Feedback from blood donors, Motivation for blood donation

   DOI: 10.5005/jp-journals-10036-1240  |  Open Access |  How to cite  | 

Abstract

Introduction: Efforts are needed to strengthen blood donor management at all levels, including educating and motivating more individuals to be involved in voluntary blood donation and converting them to retention donors. Donor retention is influenced by many factors, including the quality of blood donation experience, environment, services, wait time, and the type of interactions with the staff. It is important to develop donor feedback and a follow-up mechanism to encourage more future donations assessing the current donor management strategy. Materials and methods: This study was planned to observe the current blood donation practice at the blood bank of a tertiary-care teaching hospital in order to assess the blood donation experience and reasons and barriers for blood donation. A trained counselor interviewed a total of two hundred consecutive donors and the responses were noted on a predesigned and validated questionnaire form after taking informed consent. Results: Altruism was the most common reason for donating blood n = 107 (53.5%), while other reasons included helping a known person or an interest in gifts provided by the blood bank after blood donation (e.g., mugs, bags, stationery). The donors reported news, college motivation programs, and family discussions as the most common areas where they had heard first about blood donation, with others being workplace, camp, or public discourses. The common reasons for not donating till now were “fear of needles” n = 58 (29%), “not demanded or unrequested for” n = 40 (20%) and “fear of weakness post-donation” or asthenophobia n = 30 (15%). Conclusion: Donor satisfaction surveys and analysis helps in increased donor retention, self-confidence, and feedback for suggesting an improvement.

547

Original Article

Mayuri More, Sushil Kumar

Gum Chewing: A Novel Method for Improving Gut Motility after Cesarean Section

[Year:2019] [Month:April-June] [Volume:6] [Number:2] [Pages:4] [Pages No:76 - 79]

Keywords: Bowel movements after cesarean section, Effect of gum chewing on bowel movements, Postoperative Ileus

   DOI: 10.5005/jp-journals-10036-1243  |  Open Access |  How to cite  | 

Abstract

Background: The presence of bowel movements after any abdominal surgery is an important event and indication for switching the patient from intravenous fluids to oral feeding. Gum chewing has been reported to help in the early return of bowel sounds in patients who have undergone abdominal surgery. The present study evaluates the efficacy of gum chewing on bowel movements in postcesarean patients. Materials and methods: A total of 200 women delivered by lower segment cesarean section, under spinal anesthesia were included in the study. The patients were randomly allotted to two groups. Group I—chewing gum group and group II—control group. Two hours after cesarean section, the women in the study group received one stick of gum every four hours to be chewed for 30 minutes until regaining their bowel function. The women in the control group followed the standard postoperative care. Each woman in both groups was examined abdominally using a stethoscope to detect the intestinal sound every one hour. The following outcome parameters were noted: the time to hear the first bowel sound, time to mobilization, time to first passage of flatus, time to first feeling of hunger, the time to first defecation, and length of the hospital stay. Results: The two groups were well matched in terms of age of the patients, parity, ANC registration, gestational age, and the history of previous abdominal surgery. Outcome parameters connected with bowel movements were significantly shorter in group I (chewing gum). However, the duration of hospital stay in both groups was the same. Conclusion: The study confirms the effectiveness of gum chewing on peristaltic activity after a primary lower segment cesarean section. It is a harmless and inexpensive method for stimulating early bowel movements. Early bowel movements also mean less use of IV fluids in the post-operative period, thus early ambulation.

257

MINI REVIEW

Alaka Deshpande

Galactorrhea

[Year:2019] [Month:April-June] [Volume:6] [Number:2] [Pages:3] [Pages No:80 - 82]

Keywords: Bromocriptine, Cabergoline, Dopamine agonists, Galactorrhea, Prolactin, Prolactinoma

   DOI: 10.5005/jp-journals-10036-1236  |  Open Access |  How to cite  | 

Abstract

An inappropriate secretion of a milk-like substance from breasts is called galactorrhea. The commonest cause is over-secretion of the hormone Prolactin. Causes and management of prolactinemia are discussed in this paper. A protocol to investigate these cases has been given. The advent of dopamine agonists, which inhibit secretion of prolactin, has made the management of these cases simple and safe. All patients of hyperprolactinemia may have associated tumors in the pituitary (prolactinomas). If these are less than 3 cm in size, as seen on neuroimaging, medical management may be enough. Tumors exceeding 3 cm in size may need a surgical resection because they may produce compressive effects. Hypothyroidism must be excluded and, if present, treated appropriately.

228

REVIEW ARTICLE

Bani B Ganguly, Nitin N Kadam

Technological Challenges for Management of Genetic Complexities of Myelodysplastic Syndromes

[Year:2019] [Month:April-June] [Volume:6] [Number:2] [Pages:7] [Pages No:83 - 89]

Keywords: Chromosomal rearrangements, Mutational complexities, Myelodysplastic syndrome, Somatic mutations, Technological challenges

   DOI: 10.5005/jp-journals-10036-1239  |  Open Access |  How to cite  | 

Abstract

Background: Chromosomal abnormalities (CA), including del(3q, 5q, 7q, 11q, 12p, 17p, 20q); loss of 5, 7, and Y; trisomy(8,19); i(17q); and balanced and unbalanced translocations have been demonstrated as prognostic markers in 5-tier risk-grouping and WHO-2016 classification of myelodysplastic syndromes (MDS). However, monosomal karyotype (MK) in the presence or absence of a complex karyotype (CK) has not been considered in the WHO classification. Additionally, a plethora of somatic mutations of MDS-specific and elderly populations collected through a-CGH, SNP-array, next-generation, and targeted sequencing has led to understanding of their impact on MDS-phenotype, initiation and progression of the disease, and treatment outcome in single or cooperating effects of comutations of several pathway-mechanisms. Methods: The present review on technological challenges has been raised on the information available through Google-search using MDS-genetics, mutations of MDS, diagnosis and prognosis of MDS, etc. with a view to understanding the possibilities in low-resource settings. Results: Mutual exclusivity and cross-talk of such mutations help in self-renewal of leukemic stem cells. However, molecular screening is not only time-consuming but also expensive in poor-economic settings. Nevertheless, the significance of unspecific and uncalled mutations is yet to be understood. In contrast, conventional cytogenetic assays have specific aberrations of prognostic and therapeutic values, which cover the whole genome in a cost-effective manner. However, since somatic mutations of clonal hematopoiesis of indeterminate potential (CHIP) in asymptomatic and/or patients with idiopathic cytopenia of undetermined significance (ICUS) have the potential for favoring the leukemic onset to progression, molecular screening has inherent importance within the disease-mechanism. Conclusion: The WHO-2016 risk-classification has considered mutations of SF3B1, TP53, and MLL for management of MDS, and also powered conventional cytogenetics for diagnosis and risk-stratification of MDS.

214

SHORT COMMUNICATION

Bani B Ganguly, Nitin N Kadam

An Excerpt of Geriatric Diseases in India

[Year:2019] [Month:April-June] [Volume:6] [Number:2] [Pages:3] [Pages No:90 - 92]

Keywords: Aging, Cardiovascular diseases, Geriatric diseases, Life-expectancy, Noncommunicable diseases

   DOI: 10.5005/jp-journals-10036-1238  |  Open Access |  How to cite  | 

Abstract

Background: Aging is a consequence of accumulated effects of living conditions, acquired mutations, and an inefficient regenerative mechanism of the progenitor cells. Chronologic aging is linearly linked to an increase in health-complexities of noncommunicable types. In contrast, medical advancements is enhancing the life-expectancy—certainly at a higher cost; however, the trend could outnumber the young workforce subsequently. Hence, understanding of disease-prevalence is essential with a view to making necessary arrangements for offering appropriate care to the geriatric population. Materials and methods: Records of over 47,000 outpatient medical consultancies were retrieved from the hospital management system and considered for investigating the disease-prevalence in the older population. Results: Older population was largely affected with diseases related to the cardiovascular system followed by general medical complications. In general, men were more affected with geriatric diseases, which could largely be due to a lack of financial and other preparedness of the retirees. Conclusion: A significant osteoarthritis problem in females is undoubtedly associated with aging of ovaries. An intense look at geriatric diseases may guide for building age-friendly and dedicated accommodation at home and healthcare centers. The knowledge may be helpful for handling geriatric disease-burden of low- and middle-income countries.

233

CASE REPORT

NC Diong, S Narasimman, R Subashini, TJ Cindy

Dilemma in Managing Carcinoid Crisis Secondary to a Metastatic Well-differentiated Neuroendocrine Tumor of the Lung

[Year:2019] [Month:April-June] [Volume:6] [Number:2] [Pages:3] [Pages No:93 - 95]

Keywords: Carcinoid syndromes, Carcinoid tumors, Neuroendocrine tumors

   DOI: 10.5005/jp-journals-10036-1235  |  Open Access |  How to cite  | 

Abstract

Background: Well-differentiated neuroendocrine tumors (NET) of the lung account for 2% of all primary lung neoplasms. Less than 2% of the lung NET present with the carcinoid syndrome manifested as facial flushing, diarrhea, palpitation, and bronchospasm, as a result of a hypersecretion of hormones and peptides from the tumor. Carcinoid crisis is a life-threatening complication of the carcinoid syndrome and its manifestation as coronary vasospasm is rare. Octreotide is a gold-standard treatment to control the symptoms; however, octreotide as a triggering factor for coronary vasospasm has never been reported. Case description: A 62-year-old man presented with multiple episodes of carcinoid symptoms is referred to our hospital. A series of investigations were carried out and he was diagnosed with the lung NET with a liver and bone metastasis. He developed coronary vasospasm, which could be due to the carcinoid crisis itself or the treating agent octreotide, after initiation of octreotide for carcinoid syndromes. After intense perioperative management by multidisciplinary teams, he underwent successful symptom control by perioperative octreotide and surgery. Conclusion: Surgery is the mainstay treatment to control carcinoid syndromes or crisis. Multidisciplinary therapy in perioperative care is paramount to ensure an optimal surgical outcome.

465

CASE REPORT

Vidyanand Deshpande, Gaurav Chamle

Double Pouch Colon

[Year:2019] [Month:April-June] [Volume:6] [Number:2] [Pages:2] [Pages No:96 - 97]

Keywords: Anorectal malformation, Congenital pouch colon, Double pouch colon

   DOI: 10.5005/jp-journals-10036-1234  |  Open Access |  How to cite  | 

Abstract

Congenital pouch colon (CPC) is a rare type of anorectal malformation found mainly in North Indian states. A 2-day-old male neonate with type V CPC (i.e., double pouch colon) has been reported. This is 6th such case reported in the world literature.

206

CASE REPORT

Aaditya A Prabhudesai, Kasturi H Bandyopadhyay, Chumki A Datta, Shilpita Banerjee

Anesthetic Management in a Parturient with Complete Heart Block Posted for Emergency Uterine Evacuation: A Case Report

[Year:2019] [Month:April-June] [Volume:6] [Number:2] [Pages:3] [Pages No:98 - 100]

Keywords: Bronchospasm, Complete heart block, IUFD, Pregnancy

   DOI: 10.5005/jp-journals-10036-1241  |  Open Access |  How to cite  | 

Abstract

A 34-year-old lady in the 19th week of gestation was referred for emergency evacuation of products of conception, following intrauterine fetal death and persistent vaginal bleeding. She was suffering from complete heart block with a heart rate of 42 beats per minute. A temporary pacemaker was implanted and she was taken up for surgery. She developed an acute bronchospasm just before induction of anesthesia, which was successfully managed, without delaying the operative procedure. Her anesthetic management is discussed in detail in this paper. She was discharged on the 8th postoperative day after implanting a permanent pacemaker. Cause of her complete heart block was found to be systemic lupus erythematosus.

209

CASE REPORT

Nilay Patel

Spectrum of Depression in Children and Adolescents with Type 1 Diabetes—Report of Three Cases

[Year:2019] [Month:April-June] [Volume:6] [Number:2] [Pages:2] [Pages No:101 - 102]

Keywords: Child and adolescent, Depression spectrum, Diabetes mellitus

   DOI: 10.5005/jp-journals-10036-1244  |  Open Access |  How to cite  | 

Abstract

Sparse literature is available on mental health in the context of diabetes in children and adolescents of developing countries, such as India. We report three cases of depression in children and adolescents who are suffering from type 1 diabetes mellitus (T1DM). We found a spectrum of depression ranging from double depression to depression with somatic syndrome to severe depression with psychosis in diabetics of these age groups. We suggest that further original research may be directed in the arena of mental health in children and adolescents.

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