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   Table of Contents - Current issue
January-June 2022
Volume 8 | Issue 1
Page Nos. 1-74

Online since Saturday, February 12, 2022

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Editorial p. 1

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Low cost model of hospital pharmacy p. 2
Rajesh Harsvardhan
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Clinical communication skills in India: Current trends and future perspectives Highly accessed article p. 6
Tooba Khursheed, L V Simhachalam Kutikuppala, Akatya Vidushi Sinha, Krishna Naineni
Effective and sensitive communication by the clinicians with the patients and relatives are crucial in achieving a patient-centered consultation. Competent communication is an expertise, which all health-care professionals require, but it is the one that not all of them are obviously good at. Clinical communication skills are related to the speedy recovery of patients, provided with good adherence to the medications, and improved patient satisfaction, thereby affecting the psychological, biological, and social outcomes of the treatment. As time progressed, the situation of learning clinical communication skills has been transformed from “good to have” toward “need to have.” Teaching soft skills of communication to the medical students in a controlled environment before exposing them to real-life conditions could be the key to developing rapport with the patients, leading to more appropriate diagnosis and treatment outcomes.
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Medical cyclotron: Operational aspects and its clinical utility Highly accessed article p. 10
Rajeev Kumar, Arunav Kumar, Santosh Kumar, Sanjay Kumar Suman, Nihar R Biswas
Cyclotron is a type of particle accelerator invented by Ernest O. Lawrence in 1930 at the University of California, Berkeley and patented in 1932. Lawrence was awarded the Nobel Prize in Physics 1939 for this invention. It is based on a combination of radiofrequency acceleration and bending of charged particles in a magnetic field. This way the same electrode is used over and over again to give acceleration to the particles. Lawrence built the first cyclotron in 1931 and it produced Protons of 1.25 MeV. In a conventional Cyclotron, the charged particles move in two semicircular metal containers called Dees (because of the D-shaped electrodes). In most of the modern medical cyclotrons, there are four gaps with four pie-shaped Dees instead of two. The particles pass through the same acceleration gap many times with increasing radius before they acquire the desired energy. The entire accelerating system is maintained at high vacuum (10-6 to 10-8 Torr), and the Dees are housed in a vacuum chamber. Hydrogen gas is passed through an arc current to produce the ion source for the acceleration in the cyclotron. The ion source is pulled toward the center of Dee structure by applying a positive bias voltage. A high voltage (>36 kV) is applied to the Dee structure with the help of an oscillator. The ion located at the center is thus attracted toward a Dee that happens to be at the opposite potential at that particular moment. As the magnetic and electric fields (in Dees) in the cyclotron are at right angles to each other the ion beam moves in a circular path inside the hollow Dees. In the present scenario, negative ion cyclotron accepted everywhere in the medical field. The objective of this article is to educate the new generation of physicians and share the knowledge of medical cyclotron and its integrity mainly among our colleague apart from nuclear medicine. Hence, that they can understand about this complex and complicated equipment and its medical utility for patients benefit.
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Post-COVID, neurosurgical interventions in rhinocerebral mucormycosis, an institutional experience p. 16
Samrendra Kumar Singh, Dhananjay Kumar, Brajesh Kumar, Brajesh Kumar, Niraj Kanaujia, OP Gupta, KM Jha, Rakesh Kumar Singh
Objective: Mucormycosis is an opportunistic, fungal infection, often lethal fungal infection which occurs in immunocompromised patients. However, in this second phase of COVID-19, we faced many post-COVID mucormycosis cases at our institution, IGIMS, Patna. We present our experience in eight patients with this condition who underwent neurosurgical interventions. Patients and Methods: A prospective study for eight patients underwent neurosurgical interventions for rhinocerebral mucormycosis. All cases were operated by same surgeons from ENT and Neurosurgery. Results: Total 42 patients referred for neurosurgical opinion, out of that eight patients taken for neurosurgical interventions. Out of 8, seven patients had COVID reverse transcription-polymerase chain reaction (RT-PCR) positive and treated with steroid and oxygen inhalation and one patient had fever but COVID RT-PCR was negative and treated at home with oxygen cylinder. All of them were treated with either liposomal amphotericin B/amphotericin B or oral posaconazole. Sinus surgery was performed in all eight patients by ENT surgeons, two underwent orbital exenteration by eye surgeon, five patients underwent open craniotomy for cerebral infection while in two patients, cerebral exploration done endoscopically. Six patients survived, while two patients died. Conclusion: Patients with rhino-cerebral mucormycosis spreading outside the sinonasal cavity to the base of brain can be treated successfully to some extent by neurosurgical interventions.
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Impact of COVID on management of urological cases in a tertiary care non-COVID institute: A patient-centered study p. 23
Vipin Chandra, Vishrut Bharti, Rajesh Tiwari, Vijoy Kumar, Ahsan Ahmad, Rohit Upadhyay, Khalid Mahmood, Nikhil Ranjan
Background: Health-care systems across the globe have been overwhelmed by coronavirus disease-19 (COVID 19). It has affected non-COVID patient management as well. While service, hospital-oriented data on effect of the pandemic on urological diseases have been published, there is scarce data on patient-centered issues in urology, particularly from India. Hence, we planned this study to determine the impact of COVID on management of urological cases. Materials and Methods: This is a prospective observational single-center study conducted at Indira Gandhi Institute of Medical Sciences, Patna, from April 2020 to November 2020. Consecutive non-COVID adult patients presenting to the indoor, outdoor, and telemedicine services of the urology department of our institute were included. Patients who were moribund, having altered sensorium, severe cardiorespiratory illness, unable to understand and respond, and those unwilling to participate were excluded from the study. A questionnaire-based data were collected. The same interviewer explained the questionnaire to patients in their own language (English/Hindi/Bhojpuri) either in person or telephonically and recorded the findings. Results: Two hundred consecutive patients were screened. One hundred and fifty were included in the study. Mean age of patients was 50 ± 3.2 years. One hundred and five patients were male. Thirty-eight patients had comorbid conditions. One hundred and thirty-seven patients reported delay to consult an urologist since development of the first urological symptom. The average delay was 68 ± 20 days. Thirty-two patients suffered COVID-19 disease during the urological illness. One hundred and twelve were advised for urology consultation after the first evaluation at a local health-care center. The reasons cited for delay by these patients (n = 112) were lock-down and reduced/unavailable public transport (n = 20) and fear of contacting corona infection (n = 10), both (n = 56), suffered COVID-19 (n = 18), and others (n = 8). The distance of patients' residence from the hospital was median 50 km, with interquartile range of 5–254 km. One hundred and three patients received definitive treatment and 47 were still undergoing delays due to various reasons. Sixty-two patients were advised surgery. 25 of these 62 were found to have complications due to delay. Conclusion: Delay in all aspects of management of urological illness, including consultation, work up, and definitive treatment was observed. Of all who were advised surgery, about 40% were found to have complications due to delay in surgery.
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A meta-analysis of quality assessment reports using prevalidated tool to evaluate the quality of health-care services in three-core domains biomedical waste management, Hospital Infection Control Practices, and Patient Safety Practices in government health-care organizations of U.P. p. 28
R Harsvardhan, Ankita Srivastava, Ayush Mehrotra, Saurabh Singh, Gaurav Gupta, Shweta Kumari, Saima Alvi
Background: Improper biomedical waste management (BMWM) poses a serious threat not only to health-care providers and patients but also to the community and environment at large; hence, with an aim to promote cleanliness, hygiene, and infection control practices in government health-care facilities, GoI launched “Kayakalp-Swacchta Guidelines for public health facilities.” A meta-analysis of quality assessment reports of five government hospitals of U.P. was done with an aim to evaluate the quality of health-care services in three-core domains (BMWM, Hospital Infection Control Practices [HICPs], and Patient Safety Practices [PSPs]). Materials and Methods: Meta-analysis of quality assessment reports pertaining to three domains (BMWM, HICP, and PSP) drawing preidentified parameters from therein was done using purposive sampling technique. Data acquisition was based on record review, patient interview (PI), staff interview, and observation and vendor interview. Parameters were scored for compliance with 2, 1, and 0 score for complete, partial, and noncompliance, respectively. Results: The average compliance of five health-care organizations with respect to the conformance with quality parameters was 77.85%. Wherein, domain-specific scores were 81.42% for BMWM, 78.15% for HICP, and 64% for PSP. The individual highest score in the domains observed was 91.2%, 93.6%, and 100%, respectively. The individual lowest score observed was 58.7%, 49.09%, and 14%, respectively. Conclusion: It can be safely concluded from the overall average compliance score that quality of health-care services pertaining to the three preidentified domains in the health-care organizations is satisfactory; however, the wide gap in the individual highest and lowest score suggests an eminent need for pragmatic strategy toward improvement.
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Leukoplakia: A descriptive study p. 33
Nidhi Thakur
Aim: Leukoplakia is a common premalignant lesion associated with the use of tobacco. This study was carried out to determine the prevalence of leukoplakia in a defined population. Materials and Methods: In this study, 300 patients were included who reported to the outpatient dental department of Anugrah Narayan Magadh Medical College and hospital. The age, sex, and prevalence of leukoplakia were assessed in these patients. Results: The study revealed a prevalence of 2% in the defined group of populations. Conclusion: A high prevalence of leukoplakia needs a closer follow-up of these patients and a generalized screening for all the patients reporting to the dental department is required to reduce the number of premalignant conditions and lesions turning into malignancy.
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A Study to assess the impact of an ongoing capacity building program for nursing staff on augmentation of Knowledge, Attitude and Practice (KAP) of the trainees at Program Study Centre (PSC), Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow p. 36
Rajesh Harsvardhan, Saima Alvi, Tanvi Arora, Ankita Srivastava
Introduction: The Government of India had notified Department of Hospital Administration (DoHA), Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) as Program Study Center (PSC) to provide comprehensive training to selected candidates for Bridge Program on Certificate in Community Health Nursing. To fulfill a commitment, to assess the effectiveness of the assigned program, the PSC: DoHA, SGPGIMS endeavored to create a reliable, valid, and accurate assessment of program decisions and outcomes. Aim: The aim of the study was to assess the impact of an ongoing capacity building program for nursing staff on augmentation of Knowledge, Attitude, and Practice (KAP) of the trainees at PSC, SGPGIMS, Lucknow. Objectives:
  1. To ascertain the preintervention status of KAP among trainees of an ongoing capacity building program, through appropriately designed tool
  2. To ascertain the postintervention status of KAP among trainees of an ongoing capacity building program, through appropriately designed tool
  3. To recommend evidence-based modifiers, as feed-forward for the subsequent phases of the program, based on the analysis of the data thus obtained.
Methodology: Interventional study. Results: Preintervention score: Knowledge – 68.5%, Attitude – 75.2%, Practice – 44.65%. Postintervention score: Knowledge – 86.846%, Attitude – 82.4%, and Practice – 51.15%. Increase: Knowledge – 18.346%, Attitude – 7.2%, and Practice-6.5%. Conclusion: The training program was successful in achieving a significant improvement in trainees' knowledge and awareness regarding delivery of comprehensive primary care services which was reflected as improvement and change in their attitude. The performance was better in the postinterventional phase as compared to preintervention. Therefore, it is of utmost importance to sustain the present and provide occasions for further improvement in the knowledge and skills to health-care providers as a measure for continuous quality improvement.
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Retrospective study to know the outcome of radial head replacement in acute fracture of radial head p. 43
Anand Shankar, Rishabh Kumar, Ashutosh Kumar, Rakesh Kumar, Santosh Kumar
Background: Radial head arthroplasty is commonly used to treat acute unreconstructible radial head fractures. The purpose of this study was to report on the clinical and radiographic outcomes after radial head arthroplasty with a metallic implant for the treatment of acute radial head fractures. Materials and Methods: Seven patients with unconstructable communited acute radial head fractures were treated with radial head replacement. Patients were selected according to the indication and rejected or delayed according to contraindication. Necessary written informed consent was taken. Observation and Results: All patients had good alignment and the full range of the function of the elbow without any major complications. Radiological alignment was also comparable with the other side. Follow-up noted up to 6 months only. Conclusions: Radial head replacement can be a good alternative for the treatment of communited radial head fractures which cannot be fixed. Although longer follow-up is needed.
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A study on low-cost model of hospital pharmacy at a government healthcare teaching institute, as a feedforward measure of control p. 48
Rajesh Harsvardhan, Ruchi Kushwaha, Rakesh Gupta
Introduction: There are very few government institutes that have “Hospital Supply Chain Management” of drugs and medicines, surgical goods, vendor-managed inventory, and outsourcing of patient care and services. Instead, they continue to have traditional Store and Purchase and Accounts departments and have often failed to appreciate the power of “Business Process Re-engineering.” The traditional Store and Purchase and Accounts departments are not able to encounter the new age “Challenges and Opportunities” and are entirely dependent on funds from the government to procure medicines and consumables. Methodology: A prospective analytical study was conducted from May 2021 to October 2021 at Hospital Pharmacy at a Government Healthcare Teaching Institute, wherein frequently prescribed antibiotics, whose multidrug resistance-associated protein was very high and patient needs to procure from outside medical stores were procured directly from the pharma companies through the rate contracts instead of local vendors. Further, these antibiotics were kept at hospital pharmacy for sale by applying minimal surcharges up to maximum of 10% of the purchased price and patients were requested to procure from it rather than outside pharmacy. Results: Over the duration of 4 months, it was observed that revenue generated per month for the hospital pharmacy was between INR 8000/- and 14,000/- but at the same time, there was a remarkable reduction in out-of-pocket expenditure (OOE) of the patient, between INR 63,000/- and 2 Lakhs and there was more satisfaction among patients. Conclusions: Based on the results, it can be safely concluded that it is the need of the hour for the government-funded hospitals to make a shift from the conventional system of procurement to this self-sustainable model of procurement. It will not only enable the hospital to be financially independent by reducing the need for budgetary support from the government but will also reduce the OOE of the patients leading to more satisfaction among them.
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The clinical and radiological assessment of biplanar and uniplanar distal locking screw in tibia interlocking nail p. 56
Ashutosh Kumar, Rishabh Kumar, Anand Shanker, Rakesh Kumar, Vidya Sagar, Santosh Kumar
Background: The clinical and radiological assessment of biplanar (two coronal and one sagittal) and uniplanar (only two coronal) distal locking screw in tibia interlocking nailing. Materials and Methods: Fifty-one patients who had tibial shaft treated with intramedullary nailing were included in this study. Out of 51, 26 fractures were treated with uniplanar two distal interlocking (Group 1) and 25 fractures were treated with biplanar three distal interlocking (Group 2). Patients with closed fractures shaft of tibia treated by closed nailing were included. Fracture unions were evaluated clinically and radiologically. Results: Union time was shorter in biplanar (two coronal and one sagittal) distal interlocking group (Group 2) compared to uniplanar (only two coronal) distal interlocking group (Group 1). Mean union time in Groups 1 and 2 were 9.34 and 5.16 months, respectively. Conclusion: Biplanar (two coronal and one sagittal) distal interlocking procedure had a significantly shorter union time. Clinically, an average of 5–10' of external rotation of the leg was observed in Group 1, whereas 0–3' of external rotation of the leg was observed in Group 2 patients. Biplanar distal interlocking had more fracture union, probably because of a more stable fixation.
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Mature cystic teratoma in a peripubertal girl: Is it uncommon? p. 60
Pratibha Kumari, Satya Kumari, Jyotsna Rani, Kavya Abhilashi, Sangeeta Pankaj, Vijayanand Choudhary, Supriya Jaiswal
Giant ovarian mature cystic teratomas (MCTs) are sparsely reported and that too at extreme of age like in premenarchal or postmenopausal age group. We hereby report a case of huge MCT in a 11-year-old premenarchal girl who presented with abdominal pain and lump. Ovarian tumor in adolescent may have malignant potential and requires appropriate and vigilant preoperative work-up and counseling for optimal management with concern of preservation of fertility and potential for childbearing.
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Giant ovarian fibrosarcoma: A rare case report p. 63
Pratibha Kumari, Satya Kumari, Jyotsna Rani, Kavya Abhilashi, Kshiti Atreya, Deepak Kumar, Vijayanand Choudhary, Sangeeta Pankaj, Supriya Jaiswal
Sex cord–stromal tumors are very rare ovarian tumors. Primary ovarian fibrosarcomas are a very rare type of sex cord–stromal tumors. They arise from superficial or deep connective tissues of fascia, tendon, periosteum, and scar. They can grow either slowly or rapidly forming a giant abdominal mass similar to epithelial tumors of the ovary. Fibrosarcomas are difficult to diagnose preoperatively. Tumor marker and radiological techniques play a trivial role in preoperative diagnosis of this rare variety of sex cord–stromal tumor. Often final diagnosis is made on histopathological and immunohistochemistry reporting. Histopathological features such as high mitotic count, nuclear atypia, and herringbone pattern arrangement of spindle cells confirm a diagnosis of malignant fibrosarcoma. Ki-67 index is considered a prognostic factor for fibromatous lesions of the ovary showing aggressive nature of tumor. We report a rare case of giant ovarian fibrosarcoma in a 40-year-old woman whose diagnosis was made histopathologically due to rarity of tumor.
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Crowd-sourcing the COVID data: Advantages and pitfalls p. 66
Sandeep Patel, Shahnawaz Khan, Ritesh Kumar, Siddhartha Sharma, Vishal Kumar
Web based surveys have gained importance in last 20 years due to ease of internet access. It has proven to be a boon in terms of minimized contacts and still be able to churn out statistically valid results and on the other hand, it has faced a lot of criticism due to lack of repeatability and other scientific validity pillars. To increase the validity of such studies, a central database should be maintained and the questionnaires should be short and to the point and should take into considerations the diversity in culture and languages.
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Our experience of working in a non-COVID hospital during the first wave of the COVID pandemic p. 69
Kumar Sanjeev, Nidhi Arun, Bharti Alok Kumar, Kumar Sanjay
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Neurological manifestations of rhino-orbital-cerebral mucormycosis (zygomycosis) p. 71
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
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HPV self-sampling: A viable option for cervical cancer screening in postpandemic era p. 73
Jyotsna Rani, Kavya Abhilashi, Pratibha Kumari, Satya Kumari
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