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   Table of Contents - Current issue
January-June 2021
Volume 7 | Issue 1
Page Nos. 1-78

Online since Monday, June 28, 2021

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COVID carnage of medical education and training: Time to emaculate p. 1
Sangeeta Pankaj
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Management of dyslipidemia in chronic kidney disease p. 2
Prit Pal Singh, Amresh Krishna, Om Kumar
Dyslipidemia is one of the most important modifiable risk factors for cardiovascular morbidity and mortality in chronic kidney disease (CKD) patients. Lipid profile in CKD differs from that in general population. Even at normal or near-normal lipid levels, subparticles are more atherogenic and more pro-inflammatory. Because of altered clearance and metabolism of various lipid-lowering agents in CKD, its safety on long-term use remains a serious concern. Statins and ezetimibe remain drug of choice for most of the patients. The lowest and the safest dose of the drugs is guided by various trials. Until recently, not much study was available to formulate a guideline for these patients. However, recent studies and meta-analysis have solved this problem to some extent and that's evident with latest guidelines published by KDIGO and ACC/AHA.
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Chronic kidney disease in children p. 6
Om Kumar, Vikash Kumar Pandey, Prit Pal Singh, Amresh Krishna
Chronic kidney disease (CKD) is a major public health issue globally. Although not so common in children, its impact can be devastating with long-term consequences. Syndromal association, congenital abnormalities of the kidney and urinary tract, and other congenital anomalies usually present in childhood and have more impact in this population. Issues such as growth retardation, hormonal imbalance, psychosocial development, and transitions to adult care are specific to children and need to be addressed appropriately. With CKD, their nutritional requirement is quite different from adults and needs more careful planning and dietary modification to avoid growth retardation in these patients. Pharmacokinetics and pharmacodynamics of many drugs including immunosuppressants also differ from adults and need special considerations. Kidney transplantation is the best treatment modality available for end-stage renal disease (ESRD). Preemptive kidney transplantation is preferred to prevent growth retardation and psychosocial maladaptations in children with ESRD. Because lymphoid system development is on peak in adolescents and developing children, they are at high risk of graft rejection. Poor adherence to medication and recurrence of primary disease also affects long-term prognosis in adolescents adversely.
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Rare sites of giant cell tumor: Institutional experience p. 12
Indrajeet Kumar, Wasim Ahmed, Rahul Kumar, Sanjeet Kumar, Nishant Kashyap, Santosh Kumar, Manish Kumar
Introduction: Giant cell tumor (GCT) is a primary benign neoplasm of the bone. It accounts for 5% of all skeletal tumors. It usually originated from the long bones. It usually arises in the metaphyseal-epiphyseal area of the long bones. We report some cases of GCT at rare sites. These are clavicle, phalanx, head of fibula, distal end of the ulna, and extensor tendon sheath of the hand. Materials and Methods: All cases were investigated and managed in the Department of Orthopedics and Surgical Oncology, IGIMS, Patna, India, between March 2014 and June 2019. We surgically managed eight rare cases (5 male and 3 female) of GCT. Patients were followed up for minimum 1 year. Discussion: GCT represents about 3%–5% of all bone tumors and 21% of benign bone tumors. It is most commonly seen in early adulthood, with a peak incidence in the third decade and with a slight female preponderance; it is usually seen in the skeletally mature patient. Conclusion: GCT s of bone at rare sites present a challenge in both diagnosis and treatment because there is very few literature about them. Our study on this tumor at rare sites will throw a new insight into the proper management.
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Our initial experience in supine percutaneous nephrolithotomy p. 17
Vipin Chandra, Vishrut Bharti, Rajesh Tiwari, Vijoy Kumar, Ahsan Ahmad, Rohit Upadhyay, Khalid Mahmood, Nikhil Ranjan
Background: Percutaneous nephrolithotomy (PCNL) is a routine procedure for removal of kidney stones. We are doing this procedure in a prone position due to traditional training, but now, we have started doing PCNL in supine position also in IGIMS, Patna. Supine position is used when there is anesthesia-related contraindication for prone position, access to the ureter and pelvicalyceal system (PCS) is needed simultaneously, and in patients where only lower or middle calyceal puncture is needed to clear the stone. Materials and Methods: We have selected five patients with different stone characters to start with. All patients had undergone standard evaluation before the procedure. Standard consent for doing PCNL was obtained. We have used the usual instruments as used in routine prone PCNL cases. Use of nephrostomy tube (NT) or double-J (DJ) stent was decided at the end of the procedure depending on bleeding, residual fragments, injury to PCS, and extravasation of fluid. NT was removed after 48 h if given and DJ stents were removed after 4 weeks. Results: Three patients were male and two were female, aged 22–55 years. The body mass index range was 19.6–24.6. Stone clearance was achieved to 100% extent in every case as seen on post fluoroscopic image. All procedures were uneventful. One patient had both ureteric stone and renal stone and we did ureteroscopy (URS) and PCNL simultaneously to clear the stone. In one case of upper ureteric stone, we started with ureteroscopic lithotripsy but after retropulsion stone migrated to PCS, then in the same position, we did PCNL to clear that stone. Conclusion: PCNL is a standard procedure for renal stone using either supine or prone position. We should be accustomed to do PCNL in supine also and can utilize this position for doing PCNL. This practice will be extremely useful in patients who cannot be operated in prone position at all due to anesthesia region, due to spinal/bony deformity, or where both URS and PCNL are needed simultaneously.
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A prospective study on congenital anomalies at birth at a tertiary care teaching hospital in Bihar p. 22
Pushpa , Shubhanti Kumari
Background: Birth defect, also known as congenital anomaly, is a condition present at birth regardless of its cause. They may be structural or functional including metabolic disorders. Congenital anomalies are the important causes of stillbirth, infant and childhood deaths, chronic illness, and long-term disability. Congenital anomalies or birth defects are still not considered a significant health problem in India as they are low in the prevalence. However, scenario is changing fast. Data on the prevalence of congenital anomalies are needed to channelize the health service for the prevention and management. The objective was to study the prevalence of congenital malformations in new-borns and the associated factors. Subjects and Methods: This is a prospective study undertaken on women admitted in labor room of PMCH, Patna, from June 2018 to May 2019. All live and still born babies with congenital anomalies were included in the study. Sociodemographic factors and information of antenatal checkup of mothers recorded. Results: Out of the total 6647 deliveries, 82 babies were malformed. Incidence was 1.33%. Live babies were 60, whereas 22 were still born. The incidence was higher in multigravidas and age more than 30 years. Neural tube defect was the most common. Conclusions: Birth defect surveillance at a larger level is required to understand it's magnitude in India. Most anomalies are preventable. Prevention and management of nutritional deficiency and medical disorders such as diabetes, hypothyroidism, and cardiac diseases can reduce the incidence. Regular antenatal care, folic acid supplementation, and vaccinations should be promoted.
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Study of seroconversion for severe acute respiratory syndrome: Coronavirus 2 IgG antibody in health-care workers in a non-COVID tertiary care hospital p. 28
Rekha Kumari, Sweta Kumari, Santosh Kumar, Neha Bharti
Background: SARS-CoV-2 possess higher risk of infection to Health Care Worker (HCW) from patients or other fellow HCW. Aims and Objective: The aim of this study is to estimate the seroprevalence of SARS-CoV-2 Ig G antibody in a sample of HCW chosen randomly from a tertiary care hospital in Patna Bihar. Results: Of the 169 participants screened from 8 July to 26 August 2020, 10.1%, (95% CI: 5.97-15.62) were seropositive for IgG antibody against SARS-CoV-2. The cumulative prevalence of SARS-CoV-2 infection (presence of antibodies or past or current positive rRT-PCR) was 10.7% ( 95% CI: 6.4–16.3). Among those with evidence of past or current infection, 5.6 % (1/18) had not been previously diagnosed with COVID-19. Conclusion: We have observed a relatively low seroprevalence of antibodies among HCW at the peak of the COVID-19 epidemic in IGIMS Patna. Seroconversion occur with a mean of 14 days in HCW from the day of diagnosis with past or present infection of COVID-19.
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Prevalence of metabolic syndrome in medical students at tertiary health care center p. 35
Sudhir Kumar, Samir Kumar, Rekha Kumari, Ravi Shekhar
The most accepted hypothesis to describe the pathophysiology of the metabolic syndrome is insulin resistance, which is caused by a defect in insulin action. It is increasingly recognized worldwide, and estimated that 20%–25% of adult population in south Asia have developed metabolic syndrome. This cross-sectional observational prevalence study of metabolic syndrome was conducted over a period of 1 year (2018–2019) on a sample of 150 randomly selected medical students comprising of different semesters of MBBS course in Indira Gandhi Institute of medical sciences, Patna. The prevalence of metabolic syndrome according to the International Diabetes Federation criteria was 20% comprising 23.3% in males and 17.8% in females. The prevalence of individual parameters for metabolic syndrome was increased waist circumference (42%), low high-density lipoproteins levels (35.3%), increased triglyceride level (32.7%), increased fasting blood sugar (0.02%), and hypertension (0.03%).
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Relation of glycated hemoglobin with nerve conduction study and proprioception in patients with type 2 diabetes mellitus p. 39
Josni Khah, Tarun Kumar, Ashok Sharan, Ashok Kumar
Background and Aim: Diabetic peripheral neuropathy is a major complication of type 2 diabetes mellitus (T2DM). Association of elevated glycated hemoglobin (HbA1c) and nerve function is known, but its relationship with proprioception is still unknown. This study was conducted to find the correlation of HbA1c with nerve conduction study (NCS) and proprioception in T2DM patients. Materials and Methods: 88 patients of T2DM of <5 years duration, between the age group 30 and 60 years, participated in the study. NCS of tibial motor, peroneal motor, and sural sensory nerves was done. Proprioception was assessed by testing the absolute error scores of knee joint position sense (JPS) with a digital inclinometer. Pearson correlation coefficient was used to analyze the relation of HbA1c with NCS parameters and the knee JPS errors. Results: HbA1c showed a positive correlation with distal latency and a negative correlation with amplitude and conduction velocity. JPS errors showed a moderate positive correlation with HbA1c. Conclusion: HbA1c values have a significant relation with the development of peripheral neuropathy in T2DM patients. This effect was observed on both nerve conduction studies as well as on proprioception test.
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Rapid detection of Mycobacterium tuberculosis in pus samples of suspected cases of extrapulmonary tuberculosis by GeneXpert MTB/RIF assay and its comparison with conventional methods p. 43
Rakesh Kumar, Sweta Muni, Deepak Pankaj, Randhir Kumar, Kumar Saurabh, Shailesh Kumar, Namrata Kumari, Shivendra Kumar Shahi
Introduction: GeneXpert MTB/RIF or cartridge-based nucleic acid amplification test is a rapid diagnostic tool used for the detection of Mycobacterium tuberculosis and its resistance to rifampicin. It can be offered as a first-line diagnostic modality in suspected cases of extrapulmonary tuberculosis (TB). This study was done to evaluate the diagnostic accuracy of the Xpert MTB/RIF assay for the detection of M. tuberculosis in extrapulmonary specimens and its resistance to rifampicin. Materials and Methods: This study was done in the Department of Microbiology at Indira Gandhi Institute of Medical Sciences, Patna, Bihar, over a period 18 months from January 2018 to June 2019 in 508 patients. The analysis and interpretation of the data were performed using Microsoft excel. The quantitative data obtained were expressed as percentage in tabular form. Results: Out of a total of 508 pus samples in suspected extrapulmonary TB patients, the percentage of males was more than females with male-to-female ratio being 1.6:1. Among the testing of Mycobacterium tuberculosis by various methods, maximum detection was done by Xpert MTB/RIF assay in 37% of cases. The least number of cases were detected by Ziehl–Neelsen staining (8.1%). Rifampicin resistance was detected in 14.9% of cases (28/188) while its resistance was not detected in 85.1% of cases (160/188) among cases of M. tuberculosis detected. Many of the negative samples on fluorescent and Ziehl–Neelsen staining came to be positive with GeneXpert testing assuring the sensitivity and specificity of Xpert MTB/RIF assay. Conclusion: In today's era when we are going for TB elimination, not only rapid TB case detection but also the early determination of multidrug resistance status is of prime value. This will not only assist in the identification of the patient with disease and drug resistance but also initiate prompt early intervention and treatment and moving a step closer in achieving the goal of TB elimination.
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Stigma related to coronavirus disease 2019 among the general population in India p. 48
Shishir Kumar, Shubham Shree, Setu Sinha, Tulika Singh, Sanjay Kumar
Background: Coronavirus disease 2019 (COVID-19) outbreak has provoked social stigma and discriminatory behaviors against the people suffering from it as well as its perceived threat of contamination. The possible reasons behind such behaviors may be poor knowledge about the disease and its safety measures. This is leading to drive people in hiding their illness or preventing them from seeking health-care facilities. Objectives: (1) To identify the factors of anxiety, fear, and stigma related to COVID-19 in the general population and (2) to assess the impact of information related to COVID-19 on the stigmatized behavior of the study population. Materials and Methods: This study is a descriptive, cross-sectional, anonymous online questionnaire-based survey using mixed (quantitative and qualitative) research methods. Random sampling technique was used through online snowballing technique. Results: About 52.4% respondent's feels having potential risk of COVID very dangerous. Only 31.3% respondents felt worried and depressed with the news of COVID-19 in the past 2 weeks. Whereas, 58.6% respondents found that this pandemic has affected their mental health negatively to some extent. Overall 44.1% respondents agreed that COVID-19 has generated stigma against the specific group of people. Although 81.3% respondents did not find any discrimination against service providers or caregivers of the COVID-19 patients in their community. Conclusion: COVID-19 has created a lot of fear and anxiety among the general population, but still correct information and prior knowledge about its prevention and care have generated a positive attitude among people to fight against this disease as well as reducing stigmatized behavior related to it.
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Correlation of postoperative pain in vital versus nonvital teeth: A clinical prospective study p. 52
Rashmi Issar, Shashi Ranjan, Priyankar Singh, Deirimika Lakiang, Ravindra Kole
Introduction: The success of root canal treatment is now above 97%. Today keeping pace with this rapidly evolving field in dentistry now single visit endodontics has become more of a compulsion rather than an option. However, to embrace this change, a scientific rationale along with clinician's and patient's acceptance is mandatory. The present study compares the postoperative pain in endodontically treated teeth in vital versus nonvital teeth. Materials and Methods: Sixty patients between the age 16 and 60 years requiring root canal treatment of maxillary and mandibular single rooted teeth were selected. After access opening under rubber dam based on bleeding or absence of bleeding from the canals, three groups were divided Group I – 20 teeth were grouped as vital which showed bleeding from the canal, Group II – 20 teeth were grouped as nonvital which showed no bleeding from the canal but absence of periapical radiolucency, and Group III – 20 teeth were grouped as nonvital with periapical radiolucency. Single-visit endodontic was completed for all the teeth. Patients were asked to report about pain intensity on 1st day, 2nd day, 1st week, and 2nd week based on the scores from 0 to 3 with increasing intensity. The values were recorded and subjected to Pearson Chi-square test and Fisher's exact test. Results: Out of 60 patients, eight patients had dropped out and 52 patients reported after 2nd week. Incidence of pain was calculated for each group at the end of 1st day, 2nd day, 1st week, and 2nd week using Chi-square test. Intragroup and intergroup comparison was carried out, and it was found to be statistically insignificant (P > 0.01). Conclusion: The results of the present study favor single-visit endodontics in vital, nonvital teeth with and without periapical radiolucency. There was no significant difference in postendodontic pain in any of the groups which suggest that single-visit endodontics with stringent clinical protocol can be used in most of the teeth needing endodontic intervention.
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Volumetric-modulated arc therapy versus intensity-modulated radiotherapy on the left-sided chest wall and locoregional nodes irradiation in treating postmastectomy breast cancer patients: A comparative dosimetric analysis p. 57
Mukesh Kumar Zope, Deepali Bhaskar Patil, Umra Fatima, Satyendra Sinha, Abhijeet Mandal, Shekhar Kumar Keshri
Purpose: This study was aimed to compare the suitable treatment plan for left-sided chest wall, regional node irradiation by the intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT). Materials and Methods: Fifteen patients' computed tomography data set was import into the treatment planning system (Oncentra). Two plans were generated for each patient, the first one using the VMAT technique with two partial arcs and the second one using the IMRT technique with seven coplaner radiation portals using 3D Oncentra TPS with 6 MV photons, step and shoot treatment delivery technique with 80 leaf multileaf collimator, and 1 cm leaf width at the isocenter. The VMAT plans optimized using the collapsed cone (GPU) algorithm and IMRT plans optimized using a collapsed cone algorithm. A hypofractionated prescription dose of 40 Gy/15# was used. The VMAT and IMRT plans compared for Planning Target Volume (PTV) target coverage, homogeneity index (HI), conformity index (CI), and monitor units (MUs) were evaluated. The Organ At Risk (OAR) doses also compared. Results: A comparable PTV coverage (V95%) and mean PTV doses were observed between VMAT and IMRT plans. The PTV maximum dose was higher within IMRT than the VMAT. We observed a better HI for VMAT plans. For conformity index (CI) both plan showed no significant difference. MU values of VMAT are higher than the IMRT treatment in this study. However, VMAT plans show significantly better right lung, heart, and larynx sparing when compared to the IMRT plans. No significant difference was observed in both groups of plan for the right breast and spinal cord. The maximum dose for the left humerus head was compared for both groups of plans. Conclusions: VMAT is dosimetrically superior to the IMRT for irradiation of left-sided chest wall and regional nodes patients in terms of target coverage and OAR sparing.
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Lingual schwannoma in a 4-year-old female baby p. 64
Vinit Kumar Thakur, Sandip Kumar Rahul, Bipin Kumar, Zaheer Hasan, Ramdhani Yadav, Digamber Chaubey, Ramjee Prasad, Rupesh Keshri
Schwannoma is a benign tumor arising from Schwann cells of the peripheral nerve sheath. Although a common tumor of the head and neck region, its location in the oral cavity is uncommon. We found lingual schwannoma in a 4-year-old baby. The patient underwent magnetic resonance imaging and complete surgical excision of the mass. Histopathology confirmed the diagnosis.
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Intradiaphragmatic extralobar pulmonary sequestration accompanying eventration of diaphragm p. 67
Rupesh Keshri, Ramdhani Yadav, Vinit Kumar Thakur, Digamber Chaubey, Vijayendra Kumar, Sandip Kumar Rahul
Pulmonary sequestrations (PSs) are rare anatomical aberrations of pulmonary development. We describe an unusual case of intradiaphragmatic extralobar PSs associated with eventration of the diaphragm on the left side. This association complicated the clinical presentation and intraoperative management of the patient.
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Rhino-oculo-cerebral mucormycosis with acute kidney injury p. 70
Prit Pal Singh, Prajit Mazumdar, Amresh Krishna, Om Kumar
Rhino-oculo-cerebral mucormycosis (ROCM) is a rare but life-threatening opportunistic fungal infection that usually occurs in immunocompromised patients. Initial symptoms can be nonspecific causing a delay in diagnosis. We report a case of type 2 diabetic female with acute kidney injury who presented with fever, rhino-orbital swelling, and painful diminution of vision of the left eye secondary to infective ROCM. She was treated with liposomal amphotericin B and surgical debridement. She recovered from ROCM and her renal dysfunction improved, but she lost vision in her left eye. Our case highlights the need for early recognition of signs and symptoms so that the treatment can be initiated early before further invasion results in complete destruction of the eyeball and fatal intracranial lesions.
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Congenital mucocele of the tongue in a neonate p. 73
Zaheer Hasan, Digamber Chaubey, Vinit Kumar Thakur, Sujit Kumar
Congenital mucocele presenting over the anterior dorsum of the tongue is an uncommon condition where the infant is usually presented with fluctuant swelling in the oral cavity rarely with respiratory distress along with feeding difficulty. It was successfully managed by initial aspiration, followed by marsupialization in a neonate.
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Omental dermoid mimicking as an adnexal mass p. 76
Kavya Abhilashi, Pratibha Kumari, Jyotsana Rani, Sangeeta Pankaj
Dermoid cysts are one of the most frequently occurring ovarian tumor; parasitic dermoids however are extremely rare. Most of the omental teratomas appear to have developed from self-amputation of cysts in the ovary followed by their re-implantation into the omentum. Omental teratomas can be located in the pelvis and mimic as an adnexal mass. Preoperative diagnostic imaging methods may not provide adequate information. We present here a case of menopausal female who presented with pain abdomen and preoperative evaluation suggested an adnexal mass. However, when surgery was performed, there was no adnexal pathology; however, there was an omental dermoid. Thus, gynecologists should always keep in mind the possibility of intraabdominal ovarian teratomas in the differential diagnosis of suspicious adnexal masses during surgery. The awareness among the surgeons of such masses may help prevent misdiagnosis and delayed treatment.
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