Current Issue Volume 5, Number 3 , July-September 2018

FROM THE EDITORS' DESK
Shibban K Kaul

From the Editors' Desk

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:iv]



This issue of MGMJMS carries an interesting and informative review article about carrier screening for prevention of genetic disorders. India, with its huge population of 1.3 billion people, has high prevalence of genetic disorders. It has been estimated that each year about one million babies are born in our country with various genetic diseases like congenital malformation, glucose-6-phosphate dehydrogenase (G6PD) deficiency, amino acid metabolic disorders, Down syndrome, thalassemia sickle cell disease, neural tube defects and muscular dystrophies.


ORIGINAL ARTICLE
Jayaprakash Alva, Shrinath Rao, Boodyar S Rai, Vivek Sakthidharan, Pomaleri K Swapna, Rajesh K Jain, Sushma N Bhat, Manasi S Sawant, Ghansyam D Jindal

Study of Variability in Heart Rate, Peripheral Blood Flow and Pulse Wave Morphology Index in Health and Disease

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:101-108]



Importance of heart rate variability (HRV) came into existence with the observations of Hon and Lee in 1965 and had been used ever since for objective assessment of automatic nervous system (ANS) as well as in intensive care monitoring. Blood pressure (BP) variability has been investigated less extensively because of invasive nature or high cost of beat-to-beat BP measurement. Peripheral blood flow (PBF) variability and morphology index variability (of the peripheral pulse) have also been sparingly studied because of the paucity of physiological and clinical correlation. In continuation of these studies, the peripheral pulse from the right wrist has been recorded in 207 control subjects and 207 patients (suffering from different diseases) in resting condition (supine), and HRV, blood flow variability and morphology index variability has been derived from this data. To take care of large scatter in the value of variability parameters in control subjects, multiple observations have been made on the subject, and the average value of variability parameter has been considered for analysis in conformity with central limit theorem (CLT). The control data has shown a remarkable decrease in standard deviation and coefficient of variation and enabled use of parametric statistical analysis. Comparison of variability parameters in health and disease has been observed to be consistent with the nonparametric analysis namely Mann- Whitney test , with a correlation coefficient of 0.8675. Based on this analysis, general and specific parameters, which change in the presence of a disease, have been identified for different diseases. The observations are reported here.

Keywords: Blood flow variability, Central limit theorem (CLT), Coefficient of variation, Heart rate variability (HRV), Morphology index variability.

How to cite this article: Alva J, Rao S, Rai BS, Sakthidharan V, Swapna PK, Jain RK, Bhat SN, Sawant MS, Jindal GD. Study of Variability in Heart Rate, Peripheral Blood Flow and Pulse Wave Morphology Index in Health and Disease. MGM J Med Sci 2018;5(3):101-108.

Source of support: Board of Research in Nuclear Sciences, Department of Atomic Energy, Government of India.

Conflict of interest: None


ORIGINAL ARTICLE
Leszek Sulkowski, Maciej Matyja, Jerzy A Walocha, Artur Pasternak

Management of Hemorrhage from Dialysis Access Site: Our Experience

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:109-111]



Arteriovenous fistula (AVF) is access to choice for hemodialysis in patients with end-stage renal disease (ESRD). Hemorrhage from the access vein is a known complication. Due to repeated punctures during dialysis, the vein wall may become necrotic and may slough off leading to severe bleeding. It may end fatally if not appropriately managed. We present our experience in 14 patients who reported to our hospital with bleeding from the dialysis access vein site. After excising the necrotic material, the wall of the vein was reconstructed and covered with a skin flap. In 13 patients, we could preserve patency of AVF for future dialysis.

Keywords: Arteriovenous fistula, Cutaneous transposition flap, Hemodialysis, Hemorrhage, Vascular access

How to cite this article: Sulkowski L, Matyja M, Walocha JA, Pasternak A.Management of Hemorrhage from Dialysis Access Site: Our experience. MGM J Med Sci 2018;5(3):109-111.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Anupam Das, Sana Islahi, Manodeep Sen, Rachana Kanaujia, Gaurav Kumar, Jyotsna Agarwal

In Vitro Susceptibility of Escherichia coli and Enterococcus faecalis Isolates from Patients with Urinary Tract Infections to Fosfomycin in North India: A Retrospective Study in a Tertiary Care Center

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:112-116]



There has been a rapid rise in multidrug-resistant uropathogenic organisms. A retrospective study was carried out in our Institution, which is a Tertiary Care Center in North India, to find out susceptibility of Escherichia coli (E. coli) and Enterococcus faecalis (E. faecalis) isolates to an older generation antibiotic fosfomycin. A total of 3270 isolates from urinary samples were tested. 1701 (52.02%) were E. coli and 500 (15.29%) Enterococcus faecalis isolates. 704 (41.39%) of E. coli were found to be extended spectrum β-lactamase (ESBL) producers and 183 (10.76%) metallo β-lactamase (MBL) producers. Out of 500 E. faecalis isolates, 247 (47.4%) were high-level aminoglycoside resistant (HLAR) and 5 (1%) vancomycin-resistant enterococci (VRE). On testing sensitivity to fosfomycin, 94.89% ESBL producing E. coli, 89.16% MBL producing E. coli, 97.17% HLAR and 80% VRE were found susceptible. Overall only 1.09% of E. Coli and 1.33% of Enterococcus faecalis isolates were fosfomycin resistant. From this study, we conclude that fosfomycin may be considered as a useful oral antibiotic for the treatment of urinary tract infections with drug-resistant E. coli and/or E. faecalis.

Keywords: Fosfomycin, Susceptibility, Urinary tract infection (UTI).

How to cite this article: Das A, Islahi S, Sen M, Kanaujia R, Kumar G, Agarwal J. In Vitro Susceptibility of Escherichia coli and Enterococcus faecalis Isolates from Patients with Urinary Tract Infections to Fosfomycin in North India: A Retrospective Study in a Tertiary Care Center MGM J Med Sci 2018; 5(3):112-116.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Shivaji Pole, Devidas Dahifale, Asmita Suryawanshi

Endovascular Laser Therapy in Varicose Veins: One Year Follow-up of 200 Patients

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:117-120]



Two-hundred patients suffering from varicose veins of the great saphenous vein with chronic venous insufficiency underwent endovascular laser therapy (EVLT) in MGM Hospital, Aurangabad, Maharashtra, India. Diode laser fiber of 1470 nm wavelength was used. In a few cases, residual dilated veins were injected with sclerosants (Inj. Polidocanol). Doppler studies were carried out immediately after the procedure to confirm complete occlusion of the ablated vein, elimination of reflux and to rule out deep vein thrombosis. The procedure was carried out as a day-care procedure under local anesthesia. All patients were followed up clinically and ultrasonographically at 1 month, 3 months, 6 months and 12 months. Results were quite satisfactory. 96.5% of patients showed complete occlusion of the treated veins and 98.5% showed complete elimination of reflux at 1-year follow-up. Of the 21 patients who had venous ulcers, 20 healed completely at 1 year. Deep vein thrombosis occurred in 2.5%. All other complications were minor. We conclude that EVLT gave satisfactory results in the management of varicose veins during a follow-up period of 12 months post-procedure.

Keywords: Ablation, Chronic venous insufficiency, Endovascular laser therapy, Varicose veins

How to cite this article: Pole S, Dahifale D, Suryawanshi A. Endovascular Laser Therapy in Varicose Veins: One Year Follow-up of 200 Patients MGM J Med Sci 2018;5(3):117-120

Source of support: MGMIHS

Conflict of interest: None


ORIGINAL ARTICLE
Rajashree V Naik, Poonam M Ingole

Modified Universal Goniometer for Objective Assessment of Forward Head Posture in Clinical Settings

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:121-124]



Accurate assessment of the forward head posture needs sophisticated, high-end equipment, which may not be available always. A modified universal goniometer was designed for routine clinical use by which forward head posture can be assessed by measuring craniovertebral and craniohorizontal angles. The device was tested in 23 young male subjects by two independent tester s and was found to be reasonably accurate. The device is simple, cost-effective and reliable for use in clinical physiotherapy for objective assessment of the forward head posture.

Keywords: Angles, Assessment, Goniometer, Posture.

How to cite this article: Naik RV, Ingole PM, Modified Universal Goniometer for Objective Assessment of Forward Head Posture in Clinical Settings. MGM J Med Sci 2018; 5(3):121-124.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Sarika A Gadekar, Akshaya Goyal, Jyotika Mishrikotkar, Supriya Deshpande, Rahul Verma

Effect of Sensitization to Increase Awareness and Willingness for Eye Donation among Educated Professionals from a Non-medical Background

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:125-128]



Aim: To study the effect of sensitization on awareness and willingness for eye donation among educated professionals from a non-medical background.

Materials and methods: Two hundred and twelve participants were asked to fill a pre-designed questionnaire about eye donation before and after sensitization by an interactive audio-visual presentation. Results were analyzed using the Chi-square test and expressed in the form of a percentage. The p-value was checked at 5% level of confidence.

Results: Sensitization efforts showed a statistically significant increase in awareness about eye donation from 94.81% presensitization to 98.58% post-sensitization. Sensitization also improved the knowledge about existing and functioning local eye banks and cleared myths related to eye donation. Whereas before presentation 151 (71.22%) participants were willing to donate eye, after presentation 184 (86.79%) participants were willing.

Conclusion: By increasing the awareness of educated people about eye donation through interactive lectures, the percentage of prospective eye donors increases.

Keywords: Educated professionals, Eye donation, Sensitization. Educated people also need to be targeted for sensitization for eye donation to meet the increasing demands of the hour.

How to cite this article: Gadekar SA, Goyal A, Mishrikotkar J, Deshpande S, Verma R. Effect of Sensitization to Increase Awareness and Willingness for Eye Donation among Educated Professionals from A Non-Medical Background. MGM J Med Sci 2018; 5(3):125-128.

Source of support: MGMIHS

Conflict of interest: None


ORIGINAL ARTICLE
Leszek Sulkowski, Maciej Matyja, Artur Pasternak

Management of Vascular Access Steal Syndrome after High Flow Arterio-venous Fistula with Revision Using Distal Inflow (RUDI) Technique.

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:129-131]



Out of 377 patients of end-stage renal disease (ESRD) undergoing hemodialysis through a surgically constructed arteriovenous fistula (AVF), eight patients developed vascular access steal syndrome (VASS) with severe ischemia of the hand on the affected side. Six of these patients were treated with revision using distal inflow (RUDI) technique, in which the fistula is ligated, and an autologous saphenous vein graft is interposed between the disconnected vein and a distal artery. In all these patients, symptoms and signs of hand ischemia regressed whereas flow through the AVF was preserved. We consider RUDI an effective procedure to address VASS because of AVF.

Keywords: Hemodialysis, Limb ischemia, Revision using distal inflow, Vascular access steal syndrome, Vascular access, complications.

How to cite this article: Sulkowski I, Matyja M, Pasternak A. Management of Vascular Access Steal Syndrome after High Flow Arterio-Venous Fistula with Revision Using Distal Inflow (RUDI) Technique. MGM J Med Sci 2018; 5(3):129-131.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Sushil Kumar, Annabelle Sabu

Suggested Protocol of Training Postgraduate Students of Obstetrics–Gynecology in Internal Iliac Artery Ligation

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:132-134]



Postpartum hemorrhage (PPH) is a common cause of maternal morbidity and mortality in developing countries. A large number of patients respond to standard medical and surgical treatment, but in some, these procedures fail to stop bleeding. As a last resort, the obstetrician has two options-hysterectomy or ligation of internal iliac arteries. Many patients want to retain uterus. Internal iliac artery ligation (IIAL) becomes the treatment of choice for them. This procedure needs to be taught to postgraduate (PG) students of Obstetrics-Gynecology. We suggest a structured teaching program so that students can learn the skills adequately. It consists of three steps: (1) IIAL on cadavers in anatomy lecture hall. (2) Exposure of internal iliac vessels during elective cesarean or abdominal hysterectomy. (3) Prophylactic IIAL in cases of placenta previa with antenatal diagnosis of placenta accreta. The inclusion of a vascular surgeon in the training faculty is of great help in learning the procedure properly, especially in preventing complications like an injury to an internal iliac vein or tackling the injuries, should these occur.

Keywords: Cadaveric dissection of the internal iliac artery, Internal iliac artery ligation, Postpartum hemorrhage, Structured program for learning the skill of internal iliac ligation.

How to cite this article: Kumar S, Sabu A. Suggested Protocol of Training Postgraduate Students of Obstetrics-Gynecology in Internal Iliac Artery Ligation. MGM J Med Sci 2018;5(3):132-134.

Source of support: MGMIHS

Conflict of interest: None


REVIEW ARTICLE
Bani B Ganguly, Nitin N Kadam

Pros and Cons of Carrier Screening for Prevention of Genetic Disorders and Other Associated Issues: Review of Current Status

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:135-142]



Genetic abnormalities cause phenotypic and clinical expressions through encoding of new or altered proteins. Such irreparable aberrations are preventable by understanding the nature of alterations and nurturing prenatal and pre-implantation diagnosis. Retrospective investigation of blood-linked relatives not only prevents the transmission of genetic aberrations to future generations but also help in understanding the impact on future health. However, more than the financial factor, psychological fear and emotion contribute as major hurdles of carrier screening. Preconception and pre-implantation genetic screening and testing are discussed with pros and cons. Carrier screening has reduced the incidences of prevalent genetic abnormalities in ethnic groups such as Ashkenazi Jewish (AJ) population. Genetic screening has been discussed at population and ethnic level with expanded carrier screening along with technological challenges and ethical and policy issues. Though there is expected trauma of stigmatization in the community, carrier screening has a pivotal role in controlling transmission of genetic abnormalities to offspring and lowering the burden of untreatable abnormalities of the genetic architecture.

Keywords: Carrier screening and genetic testing, Carrier screening of Jewish Genetic Disorders, Policies and ethics of genetic screening, Prenatal and preconception genetic testing, Genetic counseling, Prevention of birth with genetic defects.

How to cite the article: Ganguly BB, Kadam NN. Pros and Cons of Carrier Screening for Prevention of Genetic Disorders and Other Associated Issues: Review of Current Status. MGM J Med Sci 2018; 5(3):135-142

Source of support: MGMIHS

Conflict of interest: None


CASE REPORT
Tushar K Biswas, Arjun S Shenoi

A Case of Charcot–Marie–Tooth Disease with Marfanoid Features

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:143-145]



Charcot-Marie-Tooth disease (CMT)/Peroneal muscular atrophy is a diverse group of inherited chronic peripheral neuropathies. Afflicted patients develop progressive weakness and atrophy in distal-muscles of limbs and deformities of hands and feet. A case of Peroneal muscular atrophy (CMT) combined with Marfanoid Features, a coincidental congenital disorder is reported because of its rarity.

Keywords: Marfanoid features, Neuropathy, Peroneal muscular atrophy (Charcot-Marie-Tooth Disease).

How to cite this article: Biswas TK, Shenoi AS. A Case of Charcot-Marie-Tooth Disease with Marfanoid Features. MGM J Med Sci 2018;5(3):143-145.

Source of support: MGMIHS

Conflict of interest: None


CASE REPORT
Vidyanand Deshpande, Mohit Aggarwal

Neonatal Hydrometrocolpos due to Segmental Vaginal Atresia: A Case Report

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:146-147]



Neonatal hydrometrocolpos due to congenital vaginal obstruction is a very rare condition. We describe our experience with a case of huge hydrometrocolpos due to transverse vaginal septum presenting as abdominal distension and urinary obstruction.

Keywords: Hydrometrocolpos, Imperforate hymen, Vaginal atresia.

How to cite this article: Deshpande V, Aggarwal M. Neonatal Hydrometrocolpos due to Segmental Vaginal Atresia: A Case Report. MGM J Med Sci 2018; 5(3):146-147.

Source of support: MGMIHS

Conflict of interest: None


CASE REPORT
Kanishka Kumar, Rohit Kumar, Ravikirti, Rupam Kumar

Lutembacher Syndrome from the State of Bihar, India: A Case Report

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:148-150]



Lutembacher syndrome refers to a combination of an atrial septal defect and a mitral stenosis (MS). It is a rare disease in which both the pathologies intermix and cause changes to the hemodynamics and resultant disease course. This is to report a case of Lutembacher syndrome from the state of Bihar.

Keywords: Congenital heart disease, Lutembacher syndrome, Mitral stenosis.

How to cite this article: Kumar K, Kumar R, Ravikirti, Kumar R. Lutembacher Syndrome from the State of Bihar, India: A Case Report. MGM J Med Sci 2018;5(3):148-150.

Source of support: Nil

Conflict of interest: None


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