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   Table of Contents - Current issue
July-December 2021
Volume 7 | Issue 2
Page Nos. 79-153

Online since Monday, December 6, 2021

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Liquid biopsy in ovarian carcinoma p. 79
Sangeeta Pankaj
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RK Dhiman, R Harsvardhan
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Efficacy of cervical orthoses in improving neck control of growing children with cerebral palsy: A narrative review p. 90
Raj Kumar, Achintya Prakash
The purpose of this study was to perform a literature review evaluating the efficacy of cervical orthosis in maintaining correct head posture and neck control in children with cerebral palsy (CP). A literature search has been conducted using the following word or phrases: CP in children, head support, neck control, and orthosis. Database search included PubMed, CINAHL, O and P Library, ScienceDirect, and Google Scholar. Only four literatures met our search criteria indicating very limited evidence in this area, with only one relevant literature in the last 5 years. Almost all studies advocate the beneficial effect of orthosis in maintaining correct head posture and improved neck control, but number of studies and level of evidence are insufficient. Furthermore, there are very limited recent literatures available, and future studies are required with appropriate orthotic devices and strong research design.
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PCL avulsion – ORIF by CC screw. Case series – Our experience at IGIMS p. 94
Manish Kumar, Anjani Kumar, Jaya Sharma, Gangdayal Sharma, Santosh Kumar
Introduction: Posterior cruciate ligament (PCL) avulsion fractures are not a very common injury but among the avulsion fractures around the knee, PCL avulsion is very common followed by anterior cruciate ligament avulsion. Various treatment modalities have been described in the literature right from nonoperative to operative fixations. Materials and Methods: A series of 7 patients having isolated PCL avulsion fracture were selected for this study. Two of them refused treatment of any types. The remaining of the five patients was treated by open reduction and internal fixation (ORIF) using CC screw through the posterior approach. Results: All patients were followed up for 1 year. Union was achieved in all the cases. At the end of the study, all were able to squat easily and could extend the knee fully. Lysholm score was excellent in three patients and good in two patients. Conclusion: It was concluded that ORIF using a CC screw with a washer is a good mode of fixation, giving good functional recovery and stable knee.
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Impact of foundation course on students: Part of a newly introduced competency-based medical curriculum for undergraduates in India p. 101
Kumar Siddharth, Sunita , Manish Kumar, Rekha Kumari
Introduction: A new competency-based curriculum was rolled out across medical schools in India from the year 2019. It aims at transforming the way an Indian medical graduate is taught and assessed. This study was aimed at assessing the impact of a month-long foundation course, a new element of the curriculum, at the beginning of the 1st year. The foundation course aims to bring students from different socio-economic and educational backgrounds on an equal footing for their way ahead. Materials and Methods: The study was designed as quasi-experimental. Freshly admitted undergraduate students were included in the study. Students with an attendance of <60% during the foundation course were excluded from the study. A questionnaire (having 2 sections) was used, one to assess computer knowledge (10 questions) and a 17-item 5-point Likert scale to assess opinion on various domains as envisaged in the foundation course. They also rated their overall impression of the foundation course. The students attempted the questionnaire before and then again after the completion of the foundation course. Data from 91 paired subjects (66 males, 25 females) were analyzed using t-test, Wilcoxon signed-rank test, etc. Results: There was a statistically significant (P < 0.05) change in mean computer scores after 1 month. A few statements on the scale, such as the importance of handwashing, indicated the previous knowledge of the students. A statistically significant change in opinion was observed in some statements on ethics, professionalism, etc. Conclusions: Foundation course will help students become more professional in their approach to modern medicine. It makes them realize the importance of ethics, communication, and gender sensitization.
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Assessment of knowledge, attitude and practices regarding awareness of biomedical waste management among health care professionals in a tertiary care center in Patna: A cross sectional survey p. 106
Ranveer Kumar, Richa Sinha
Background and Objectives: Effective management of biomedical waste (BMW) is of paramount importance to avoid health hazards to care providers. The present study aimed to assess the knowledge, attitude, and practice of bio-medical waste management among the health care workers (HCWs) at a tertiary care center in North India. Materials and Methods: We conducted a questionnaire-based cross-sectional survey with closed-ended questions between June 2019 and October 2019. Results: Among 306 participants, 35% (107) were doctors, 52% (159) were nursing staff, 10% (31), and 3.26% (10) were laboratory technicians and cleaning staff, respectively. While >95% of doctors and nursing staff were aware of the BMW management, biohazard risks, categorization of waste, and personal protective measures, 55% of cleaning staff had not even heard about it. Less than half of the sanitation workers who segregate and transport the BMW were aware about the disinfection process (33%), transmission of HIV (44%), and permanent disposal of BMW (33%). Conclusion: Disparity in awareness about BMW management exists among HCWs. The sanitation staffs who handle the maximum amount of BMW are the most ignorant. Frequent surveillance and focused teaching sessions may help to improve the knowledge of HCWs and inculcate healthy practice.
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A retrospective study on role of HSG in evaluation of female infertility p. 111
Huma Nishat, Kalpana Singh, Bhawana Tiwary, Shubhanti Kumari, Kumari Shashi, Manisha Kumari
Aims and Objectives: Hysterosalpingogram (HSG) is one of the investigations used to evaluate female infertility. The objective of this study was to assess the role of HSG in evaluation of female infertility. Materials and Methods: A retrospective study conducted at IGIMS, Patna. The data collected were the infertile patients in whom HSG procedure performed among the women attending between November 2016 and November 2018 were included. Results: The study included a total of 130 cases of infertile women, in which 70% of cases were of primary infertility and 30% were of secondary infertility. About 83% of cases were of normal tubes with bilateral spillage. Conclusion: The retrospective study showed that HSG is a safe, lesser invasive, and cost effective and a valuable diagnostic procedure.
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HPV vaccination program: Hurdles and challenges in a tertiary care center! p. 114
Pratibha Kumari, Satya Kumari, Jyotsna Rani, Kavya Abhilashi, Setu Sinha, Sangeeta Pankaj, Seema Devi
Introduction: Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide, infecting three of four individuals at least once in their lifetime. The virus exists in more than 200 morphogenic strains, and some of these variants are oncogenic. HPV is detected in virtually all cases of cervical carcinoma. HPV vaccination against high-risk HPV types is expected to reduce the burden of cervical cancer, but for this, it has to overcome a lot of obstacles and challenges in its way. Materials and Methods: In May 2018, HPV immunization program was started in the Department of Gynecology Oncology, IGIMS, PATNA – a tertiary care center of Bihar for daughters of hospital employees and their relatives of age group 9–26 years of age. A total of 60 girls got vaccinated under this program. Results: About 80% of the parents who got their daughters vaccinated in the study were aware of cervical cancer, but they lacked knowledge about HPV – the causative agent of cervical cancer. About 50% of them were not aware of existence of any vaccine against it. Young adolescent girls were not aware of this vaccine either. Conclusion: Three-dose schedule was a major barrier to the delivery and uptake of the HPV vaccine. Had a single dose of HPV vaccine been effective that would have been important logistics advancement. Lack of knowledge about vaccine is a problem that leads to low vaccination coverage.
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Abdominopelvic mass in adolescents and young adults: An audit in a tertiary care center p. 119
Pratibha Kumari, Satya Kumari, Jyotsna Rani, Kavya Abhilashi, Sangeeta Pankaj, Vijayanand Choudhary, Pravin Kumar
Background: The present study aimed to review the clinicopathologic profile of adolescent and young adult patients of abdominopelvic lump. Materials and Methods: The hospital records of the patients of age 10-29 years who underwent surgical intervention for suspected ovarian tumor at gynecological oncology department in a tertiary hospital were searched retrospectively for demographic characteristics, clinical findings, range of tumor markers, the surgical procedure patients underwent, and the histopathological findings of adnexal masses. The duration of the study was of 18 months (from August 2019 to February 2021). Result: During this period, 27 patients of age 10–29 years with abdominopelvic mass were operated. Out of 27, 14 patients had malignant ovarian mass and 13 were of benign nature. However, 3 patients had tumor of nonovarian origin. In the study, immature teratoma ranked first among malignant tumor, while inflammatory pathology was dominant in the list of benign adnexal tumor. There was a fair correlation between tumor markers and histopathological characteristics of the tumors. Conclusion: The study highlights the importance of early diagnosis and optimal management of adnexal masses in adolescents and young adult females for better outcomes. Fertility - sparing surgeries should be considered in indicated cases.
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Mucormycosis during COVID-19 era: Double whammy in the pandemic p. 124
Kunal Kishor, Shashi Singh Pawar, Manish Kumar, Shraddha Raj, Dinesh Kumar Sinha, Deepak Kumar, Abhishek Kumar, Abhinandan Kumar, Anupam Anand, Swati , Yasmin Nasir, Sangeeta Pankaj, Rajesh Kumar Singh
Backgrounds and Aims: In April − May 2021, India has witnessed a large number of cases of mucormycosis during the second wave of COVID-19 infection both in recovered patients and those in the active phase of disease. Poorly controlled diabetes mellitus, drugs-induced immunosuppression, posttransplantation, and hematological malignancies are the major risk factors for both severe COVID-19 and mucormycosis. This unprecedented rise in COVID-19 infection led to a near collapse of the health-care system with severe shortage of treatment facilities including health-care staff and infrastructure. COVID-19 has highlighted several loopholes in the present health-care system. Most of the existing workforce had to be diverted to treat this disease and its complications. Our aim is to analyze the various clinicopathological characteristics of patients with mucormycosis and COVID-19 by an oncology department in association with the multidisciplinary team of a tertiary care center during the second wave of COVID-19 pandemic. Materials and Methods: A retrospective observational study was conducted at the oncology ward of a tertiary care center. All biopsy-proven mucormycosis patients were enrolled in the study. A detailed history along with comprehensive clinical examination and imaging studies was done. Surgical intervention and medical management were done by a multidisciplinary coordination team as per the ICMR protocol. Results: Forty-five patients were enrolled in the study. All cases of mucormycosis occurred in COVID-19 recovered patients. The median age was 52 years. Diabetes mellitus was present in 38 of 45 cases (84%). Periorbital swelling, ocular pain, ptosis, and loss of vision were the main presenting complains. The maxillary sinuses were the most common sinuses affected (45%). Intraorbital extension was seen in five cases (11%). Intracranial extension was seen in nine cases (20%). All patients had received steroids during the COVID-19 treatment. Conclusion: Poorly controlled diabetes and indiscriminate use of immunosuppressive drugs including steroids have emerged as predisposing factors for causation of mucormycosis in COVID-19 disease. In suspected cases, early initiation of therapy and rapid reversal of underlying predisposing risk factors play a key role.
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Stress among current and future dental practitioners during COVID-19 lockdown: A cross-sectional study p. 128
Nimmi Singh, Devika Singh, Navin Mishra, Priyankar Singh, Sanjay Kumar, Arbind Sharma
Aim: The aim of this study is to assess the psychological effects of the lockdown during the COVID-19 pandemic among the dental practitioners and students of dentistry. Materials and Methods: A questionnaire was prepared using the Google forms which were circulated among the dental surgeons. Statistically analysis was performed. The responses were then tabulated. Results: A total of 247 responses were received. Among them, the majority of the participants had moderate stress, i.e., 33.2% and 15.8% were suffering from severe stress. The major reason for stress of loss of income, liabilities to pay loans, and how and when to resume work. Conclusion: Social support is an important protective factor to reduce mental stress. The implications for the management of such situation during the pandemic should be given thought.
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Gliomatosis peritonei with ovarian teratoma: A report of three cases and literature review p. 132
Kavya Abhilashi, Pratibha Kumari, Satya Kumari, Jyotsna Rani, Sangeeta Pankaj, Vijayanand Choudhary, Reecha Singh
Gliomatosis Peritonei (GP) is a rare condition characterized by the presence of neuroglial implants throughout the peritoneum. It is a benign lesion with a potential for malignant transformation. Its association with ovarian teratomas has been sparsely reported in the literature. As GP is a rarity, it lacks forth set and accepted guidelines for management. Here, we report three intriguing cases of histopathologically confirmed GP in association with ovarian teratoma. All three patients were young females between 18 and 22 years of age and presented with abdominal swelling and ascites. On evaluation, they had raised tumor markers (CA-125, Agence France-Presse, and lactate dehydrogenase) and radiological findings were in favor of ovarian malignancy. Two of them underwent primary debulking surgery, whereas one received neoadjuvant chemotherapy in view of recurrent ovarian tumor of nonseminal germ cell nature followed by interval debulking surgery. Intraoperative findings in all three cases were almost similar. Unexpectedly, the histopathological findings were reported as immature teratoma in two cases and mature teratoma in one along with GP.
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Post-COVID rhino-cerebral mucormycosis: Lidocaine infusion for stable peri-operative hemodynamic p. 136
Nidhi Arun, Annu Choudhary
Mucormycosis emerged as major post COVID complication in India. Its management involves Amphotericin B and surgical debridement. Anaesthesia becomes challenging in such patients due to compromised patients, extensive surgery and side effects of Amphotericin B. We present the successful management of a rhino-cerebral mucormycosis patient with lidocaine infusion.
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Bilateral focal osteoporotic marrow defect associated with adenomatoid odontogenic tumor of mandible p. 139
Shashi Ranjan, Rashmi Issar, K M K Masthan, N Aravindha Babu, Priyankar Singh, Kumar Tathagat Singh
A case previously treated by surgical enucleation for adenomatoid odontogenic tumor involving from right parasymphysis to left parasymphysis region of mandible in a young female patient 3 years back reported with pain over left posterior region of mandible in a private dental clinic. Clinical examination revealed no dental pathosis in involved area. Panoramic radiograph revealed irregular multilocular radiolucency with foci of radiopacity with sclerotic borders involving periapical region of canine to second molar teeth till lower border of left side mandible. Incidentally, similar radioluceny was seen over the right posterior side of mandible periapically. Previously enucleated midline lesion revealed normal healed area without any sign of recurrence. As the lesion seemed to be bilateral, radiographical differential diagnosis was difficult, and lesions included were florid cementosseous dysplasia, multiple odontogenic keratocyst of basal cell nevus syndrome, ameloblastoma, and metastatic tumor to jaw. Histopathologically, the left posterior lesion was diagnosed as focal osteoporotic marrow defect, and right side lesion was considered as same. We are reporting a case of bilateral focal osteoporotic marrow defect along with previously enucleated adenomatoid odontogenic tumor, and purpose of this case report to correlate a relationship between the two different lesions whether focal osteoporotic marrow defect arise in response to adenomatoid odontogenic tumor or is incidental finding.
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A large desmoid fibromatosis of mesentery presenting as ovarian tumor - A rare case report p. 143
Kavya Abhilashi, Pratibha Kumari, Satya Kumari, Jyotsna Rani, Zeenat Sarmadi Imam, Manisha Kumari, Vijayanand Choudhary, Sangeeta Pankaj
Desmoid fibromatosis is a rare tumor of locally aggressive nature and associated with a high risk of recurrence. Although it possesses benign morphologies such as the absence of necrosis and atypical mitoses, it is classified as an intermediate malignant neoplasm due to its potential of infiltrating into the adjacent structures and the high rate of local recurrence even after excision. A 22-year-old unmarried female came with the complaint of abdominal pain and lump. The preoperative diagnosis was in favor of ovarian leiomyosarcoma but to the surprise intraoperative, tumor was found to be arising from mesentery of ileum. Following the complete resection, tumor was sent for histopathology. The histopathology examination report along with immunohistochemistry was suggestive of desmoids fibromatosis. Mesenteric desmoids fibromatosis is a rare tumor. It should be differentiated from gastrointestinal stromal tumor, leiomyoma, leiomyosarcoma, neurofibroma, and solitary fibrous tumor because of its completely different management and outcome. Histopathology and immunohistochemistry is the key for its diagnosis.
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Need and role of continuing medical education programs to produce lifelong learners p. 146
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
The branch of medicine is extremely vast and it keeps advancing with each day, and thus, there is an immense need that all medical students should develop competency of being lifelong learner. Regular participation in continuing medical education (CME) programs seems to be the solution to the challenge of staying abreast with the recent developments in medicine. The topic for any CME should be decided with the help of a thorough needs assessment either using a subjective or objective approach. The need assessment should be followed by the formulation of specific learning objectives and decisions about the format of the planned CME. In conclusion, CME programs are the answer to improve the knowledge and skills of healthcare professionals and thereby ameliorate the quality of care. It is the need of the hour to motivate doctors to periodically participate in such programs and in the process to become self-directed and lifelong learners.
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Kuppuswamy and Prasad's socioeconomic status scale: An update for base year 2016 and May 2021 p. 148
Shardhanjali Sinha, Aniket Kumar
Socioeconomic status (SES) is the predictor of the health status of an individual and a nation at large. It is one of the modifiable risk factors, measured by many researchers for estimating its impact on multiple health indicators. The actual impact of SES can only be estimated by updating the SES scale in accordance with the factors subsisting in the present scenario. Among all socioeconomic parameters, income is considered as the core parameter of SES that keeps on changing its value over time. The income of an individual or a household is a widely used marker to assess the socioeconomic position in all settings, either rural or urban. Therefore, we have attempted to update the income scale of the two most popular SES classification scales, i.e. Kuppuswamy and B. G. Prasad's SES scale for the base year 2016 and for the month of May 2021.
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Crouzon syndrome: A rare case report in perimenopausal women - Correspondence p. 152
Mayank Nilay
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