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   Table of Contents - Current issue
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October-December 2021
Volume 8 | Issue 4
Page Nos. 321-460

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EDITORIAL  

Hysterectomy: Rates and routes controversies Highly accessed article p. 321
Sushil Kumar, Tanya Vijan
DOI:10.4103/mgmj.mgmj_92_21  
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ORIGINAL ARTICLES Top

Study of human epidermal growth factor receptor (HER2/neu) expression in primary colorectal carcinoma in a tertiary care hospital Highly accessed article p. 325
Mousmi Agrawal, Suparna S Pingle, Chandrashekhar Prabhakar Bhale
DOI:10.4103/mgmj.mgmj_83_21  
Introduction: Colorectal cancer (CRC) mainly affects the middle-aged and elderly population with a gradual increase in its incidence. Various studies have found human epidermal growth factor receptor (HER2/neu) overexpression in CRC and its associated prognostic outcome. HER2/neu activates various signaling pathways which leads to cell proliferation and survival, and thereby its overexpression causes excessive tumor cell growth and migration. Aims and Objectives: The aim of this study was to determine the percentage of HER2/neu positive and negative cases and to correlate it with the grade and stage of the tumor. Materials and Methods: The study was carried out for 2 years in the Department of Pathology, MGM Medical College and Hospital, Aurangabad, and included 35 resected specimens of colorectal carcinoma. Histopathological examination was studied and for immunohistochemical (IHC) staining, paraffin wax-embedded tissues were immune stained for HER2/neu. Results: Of 35 cases, there were 18 women and 17 men. Approximately 28.57% cases were in the age group of 41–50 years with the mean age being 54 years. In 37.14% of cases, the tumor was located in the ascending colon. Approximately 77.14% cases were Grade 2. In total, 57.14% cases were at stage T3. Six cases were HER2/neu positive and 29 cases were HER2/neu negative. Conclusion: A significant correlation was found between HER2/neu expression with histologic grade and stage of the tumor. HER2/neu targeted therapeutic strategies have the potential to change treatment course and outcome. Hence, HER2/neu can be used as a biomarker in patients with CRC to assess their prognostic outcome.
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Association of basal metabolic rate with respiratory function among middle-aged obese and nonobese subjects p. 330
Afreen Begum H Itagi, Ambrish Kalaskar, Pasang Tshering Dukpa, Dhruba Hari Chandi, GY Yunus
DOI:10.4103/mgmj.mgmj_68_21  
Background: Obesity is proved to be a comorbid condition in various metabolic, cardiovascular, and pulmonary disorders. Only a few investigations analyzed the relationship between basal metabolic rate (BMR) and lung function in middle-aged obese individuals. Objectives: The aim of this study was to determine the relationship of BMR to that of pulmonary functions among middle-aged obese subjects. Materials and Methods: This cross-sectional study was undertaken in obese and nonobese healthy subjects (50 each) of age 35–55 years. Body mass index (BMI), body fat percentage (BF%), fat mass (FM), and fat-free mass (FFM) were estimated, and BMR was calculated using predicted equations. Spirometric measures such as forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, and peak expiratory flow rate (PEFR) were measured. Maximum voluntary ventilation (MVV) and mean forced expiratory flow during the middle of FVC (FEF25%–75%) were determined. Descriptive statistics, t test (unpaired), and Pearson’s correlation test were used for the analysis of the variables. Values of P ≤ 0.05 were considered statistically significant. Results: Mean BMR among obese was significantly higher than nonobese. The pulmonary function parameters FVC, FEV1, and FEF25%–75% were significantly reduced in obese. A significant positive correlation of BMR was found with FVC, FEV1, PEFR, FEF25%–75%, and MVV among both obese and nonobese. An inverse correlation existed between BMR and FEV1-to-FVC ratio in the study participants. Conclusions: Pulmonary functions are more closely associated with fat distribution than with the extent of obesity. The study outcome suggests that, in the context of early lung function alterations in the middle-aged obese subjects, it is necessary to take into account the BMR and body composition instead of BMI alone.
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Efficacy of intrathecal fentanyl versus buprenorphine as an adjuvant to isobaric levobupivacaine in lower limb surgeries: a comparative study p. 336
Preet Hiten Furia, Vasanti Mukund Sasturkar, Sanhita J Kulkarni, Pradnya Shripad Joshi, Pramod V Bhale
DOI:10.4103/mgmj.mgmj_45_21  
Background: Fentanyl and buprenorphine are the most commonly used adjuvants in spinal anesthesia. There is paucity in literature regarding the comparison of these two adjuvants when used with levobupivacaine. Aim: This study aimed to compare the efficacy and safety of fentanyl and buprenorphine added to isobaric levobupivacaine. Materials and Methods: This prospective randomized double-blind study was undertaken on 60 patients between the ages of 18 and 65 years with the American Society of Anesthesiologists (ASA) physical status 1, 2, and 3 scheduled for lower limb surgery. Group LF (n = 30) received 3-mL isobaric 0.5% levobupivacaine with 10 microgram (mcg) injection fentanyl and Group LB (n = 30) received 3-mL isobaric 0.5% levobupivacaine with 60 mcg injection buprenorphine. Characteristics of sensory and motor blockade, duration of postoperative analgesia, hemodynamic parameters, and adverse effects were recorded. Data were analyzed by appropriate statistical tests and a value of P < 0.05 was considered significant. Results: The onset of sensory block and duration of motor block in both groups were comparable (P > 0.05). The onset of motor block, duration of sensory block, and duration of analgesia were significantly prolonged in Group LB than Group LF (P < 0.05). Six patients in Group LF and three patients in Group LB developed nausea, although the difference was not statistically significant (P = 0.2801). None of the patients in either of the study groups had adverse effects such as bradycardia, hypotension, pruritus, or respiratory depression. Conclusion: Combinations of 0.5% isobaric levobupivacaine (3 mL) with fentanyl (10 mcg) and buprenorphine (60 mcg) show a good safety profile when administered intrathecally, although combination of levobupivacaine–buprenorphine is superior in terms of prolonged sensory block and longer duration of postoperative analgesia.
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Comparison of intraoperative and postoperative outcomes of nondescent vaginal hysterectomy and total laparoscopic hysterectomy p. 342
Ganesh Tondge, Priyank Singh Dasila, Nandkishore More, Suvarna Kale, Swapnil Shelke
DOI:10.4103/mgmj.mgmj_48_21  
Introduction: Nondescent vaginal hysterectomy (NDVH) and total laparoscopic hysterectomy (TLH) are the two approaches used to perform a hysterectomy in a nonprolapsed uterus based on indication for surgery, size of the uterus, availability of types of equipment, skills of the surgeon, and patient’s preference. Each surgical approach has its own merits and demerits. Materials and Methods: A prospective and comparative study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care center from December 2018 to November 2020 to compare the intraoperative and postoperative outcomes of NDVH and TLH. A total of 80 patients (40 in NDVH and 40 in TLH group) were calculated based on the average number of hysterectomies (mainly TLH). All patients admitted to the hospital for NDVH and TLH were selected based on the selection criteria. Results: The mean age group irrespective of the route of surgery is found to be within the age group of 41–45 years. The majority of the patients who were operated on were diagnosed to have fibroids as the main cause for their complaints followed by adenomyotic changes and hyperplasia. The mean blood loss of NDVH was found less as compared to TLH but not significant as P value >0.05. The mean number of days for a hospital stay for NDVH is 4.26, whereas the hospital stay for TLH patients was found to be 4.7 days that is greater as compared with NDVH. The most common complication irrespective of the type of surgery is urinary tract infection followed by pyrexia. Conclusion: Considering the outcomes and cost-effectiveness of both routes of surgery, it is found that nondescending vaginal hysterectomy is more advantageous over total laparoscopic hysterectomy.
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Infection of mucormycosis inpatients in Covid-19: an experience at the tertiary medical center in Maharashtra, India p. 349
Harshul Sharma, Shivaji Pole, Gaijala Sabatina, Rishika Saraf, Saurabh Joshi, Devidas Baburao Dahipale, Prassana S Mishrikotkar
DOI:10.4103/mgmj.mgmj_64_21  
Introduction: Mucormycosis is a rare infection known to be one of the most rapidly progressing and lethal forms of fungal infection in humans, with a high mortality rate of 70–100%. Covid-19 cases were reported from all states of the country, but cases of mucormycosis in the setting of COVID-19 pneumonia were very low and that too reasoned that this was most likely due to the patient’s immune-compromised condition. Aims and Objectives: The aim of this article is to assess mucormycosis in Covid-19 patients and its association with the immune status of patients. Materials and Methods: Over 5 months, from February 2021 to June 2021, a retrospective observational study was conducted at MGM Medical College, Aurangabad, Maharashtra, India. The study included all patients who came for imaging to the Radiology Department with mucormycosis who were either coronavirus-positive or had recovered from coronavirus infection. All patients with a molecular diagnosis of SARS-CoV-2 infection admitted to our hospital and having a clinical diagnosis of invasive fungal infections were included. Results: All 30 (100%) patients were diabetic; 17 of these had uncontrolled blood sugar levels with HbA1C levels >6.5%, and the remaining 13 patients had controlled diabetes. The majority of uncontrolled diabetics (17 out of 30) had invasive mucormycosis, rhino-orbital mucormycosis and rhino-orbital cerebral stage, whereas only 3 subjects with control diabetes had invasive mucormycosis. Five uncontrolled diabetic patients had rhino-orbital cerebral stage, whereas only two controlled had rhino-orbital cerebral stage. There is a significant difference between controlled and uncontrolled diabetes with P-value of 0. Conclusion: Covid-19 connection to invasive mucormycosis infection is extremely dangerous and should be taken seriously. Uncontrolled diabetes and inappropriate use of steroids during the management of Covid-19 are two of the most common causes of disease aggravation, and both must be addressed.
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Incidence and determinants of acute kidney injury following Mannitol therapy p. 355
Mary Grace, Geo A J Paul, Varada Aravindan, C M Muhammad Afzal, Breeze Ann Joy, Nalakathkarappamveetil Muthu Ajmal
DOI:10.4103/mgmj.mgmj_46_21  
Background: Mannitol is a commonly used drug in general medicine and neuro medicine wards. Mannitol reduces intracerebral pressure by redistributing water from the brain parenchyma. Renal failure is cited as one of the most common side effects and concern over this often limits the use of Mannitol. This study is intended to find out whether the use of Mannitol, in the doses commonly used in our setting, is associated with derangement of renal function and if so what are its determinants. Materials and Methods: We did a prospective observational study on 151 consecutive patients. The duration of the study was for one year from January to December 2020. Mannitol was used in the usual dose of 100 ml of 20% solution 8 hourly. Acute kidney injury was diagnosed based on the KDIGO criteria. Results: The study population included 103 males (68%) and 48 females (32%). The age group ranged from 14 years to 98 years. A total of 42 patients (27.8%) developed acute kidney injury of which 26 were males (62%) and 16 were females (38%). By multiple regression analysis, age more than 65 years and diastolic blood pressure more than 100 mm of Hg were the two significant predictors for the occurrence of acute kidney injury. Conclusion: Mannitol is a safe drug that can be used to reduce intracerebral pressure, provided the dose of the drug is carefully monitored, especially in those with risk factors such as advanced age and high diastolic blood pressure. An equally important aspect is the early recognition of the renal impairment because stopping the drug will in most situations reverse the damage. Since any renal impairment, however small and short-lasting, can have adverse long-term effects, such insults must be avoided as far as possible.
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Health implications of knowledge, and attitudes for road safety and protective measures among commercial motorcycle riders in a semi-urban setting in Nigeria p. 361
Olaide Lateef Afelumo, Olaiya Paul Abiodun, Olaniyi Felix Sanni
DOI:10.4103/mgmj.mgmj_59_21  
Background: Knowledge of road safety and preventive measures effectively reduces accidents associated with motorcycles. This study aimed to assess the knowledge and attitudes of motorcycle riders in the Ado-Odo Ota local government area (LGA) towards road safety and accident preventive measures. Materials and Methods: This study was a descriptive cross-sectional study that used a structured questionnaire to collect data related to knowledge of safety measures from the respondents using a stratified random sampling technique to identify potential respondents. IBM-SPSS version 25.0 for Windows IBM Corp., Armonk, NY, USA, was used for data analysis. Results: There were 374 respondents, of which 69.0% owned the motorcycles, and 31.0% were hired/rented. The knowledge of road safety and preventive measures among respondents was generally poor (46.5%). Rented/hired motorcycle riders displayed better knowledge (55.2%) than owners (42.6%) (P < 0.05). Factors associated with knowledge include being married COR = 2.48 (95% CI = 1.22–5.08; P < 0.05), secondary/higher education COR = 1.90 (95% CI = 1.19–3.05; P < 0.05), and over 6-year of experience COR of 1.69 (95% CI = 1.08–2.63; P < 0.05). Motorcycle owners displayed better attitudes (71.7%) than hired (57.8%) (P < 0.05). Secondary/higher education COR 1.24 (95% CI = 0.78–1.97; P > 0.05), and good knowledge COR = 4.15 (95% CI = 2.50–6.91; P < 0.005) were the determinants of positive attitudes towards safety measures. The overall prevalence of road traffic crashes was 45.2%, higher among riders with insufficient knowledge (47.5%) and negative attitudes (55.7%) towards safety measures. Conclusion: The government and other stakeholders should organize regular training to improve the riders’ knowledge and attitudes towards road safety and preventive measures due to the riders’ inadequate knowledge of safety and protective measures. These actions will help reduce accident rates and consequently reduce road traffic crashes’ medical and economic burdens.
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Awareness in the general population about binocular single vision and its importance p. 370
Snehal Rhishikesh Thakre, Karan R Nathani, Pradnya Ashish Deshmukh, Jyotika Prasanna Mishrikotkar
DOI:10.4103/mgmj.mgmj_49_21  
Introduction: Stereo vision adds an extra dimension to aid depth perception and gives a binocular advantage in task completion. Aim: To study the perception of the presence and importance of binocular vision in the general population. Materials and Methods: A standard questionnaire in the local language was circulated amongst 500 people in the outpatient department (OPD). Group 1 had studied < 12th standard, and Group 2 had studied up to 12th standard or more. Results: More participants in Group 2 said that the purpose of having two eyes was to see, for aesthesis, and also for a better quality of vision than those in Group 1 (P = 0.011 s); they knew that it was advantageous to have both eyes work together as one unit than did those in Group 1. (P = 0.010 s) Similarly, Group 2 knew why a squint developed (P = 0.002) and that there was a relationship between a squint and binocular single vision (BSV) (P = 0.000). Group 2 knew that a squint could be treated (P < 0.0001 s). Group 1 did not know the importance of the early treatment of strabismus (P < 0.0001 s). Participants in both groups were aware that they could face difficulty in doing certain jobs due to less vision in one eye (P = 0.201 ns); as well as that visual impairment in children could be prevented in at least some children if vision testing was done during the preschool years. Conclusion: It is important to raise awareness among the general population of the concept of binocular vision and its relationship to strabismus.
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Comparison of the efficacy of homemade herbal disinfectants with chlorhexidine for decontamination of toothbrush: a randomized controlled trial p. 375
Ankita Singh, Anuradha Palshikar, Tanushri Chatterji
DOI:10.4103/mgmj.mgmj_52_21  
Introduction: A toothbrush is the most common oral hygiene aid used, but maintaining and storing the toothbrush hygienically is commonly neglected. In India, people are not aware of the contamination of toothbrushes. Contaminated toothbrushes can act as a vector for the transmission or reinfection of various bacteria, viruses, and fungi. The herbs, which have pharmaceutical properties, can be used as an alternative. The study aimed to compare the antimicrobial efficacy of 3% neem and 3% garlic on Streptococcus mutans and to compare with 0.2% chlorhexidine mouthwash as toothbrush decontaminants. Materials and Methods: A triple-blinded randomized controlled trial was done on 120 subjects. The subjects were divided into four groups: Group I (distilled water), i.e., control, three study groups having 3% neem (Group II), 3% garlic extract (Group III), and 0.2% chlorhexidine gluconate (Group IV). Subjects were provided toothbrushes and toothpaste for both baseline and intervention phases. The toothbrushes were collected after 14 and 28 days for microbial analysis in both phases. The data were analyzed and compared using appropriate t-test and analysis of variance. The level of significance was set at P < 0.05. Results: Garlic (Group III) was most effective at 98%, followed by chlorhexidine (Group IV) 96% and neem (Group II) 88% in reducing the level of S. mutans. Distilled water (Group I) showed only a 3% reduction. Conclusion: Neem and garlic proved to be as effective as chlorhexidine, and these herbal products can be used as an alternative to chlorhexidine as disinfectants for toothbrushes. These are the common ingredients that can be easily found in Indian households. It is herbal, cost-effective, and has no side effects so it can be easily used by every individual as a toothbrush decontaminant.
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Echocardiographic abnormalities in patients with chronic liver disease: Observations from Thrissur, Kerala, India p. 383
Mary Grace Jacob, Saji Sebastian, Geo Paul, Mukundan Chelakkat, Ajmal NM, Breezy Anna Joy, Mohammed Afsal
DOI:10.4103/mgmj.mgmj_84_21  
Background: Chronic liver disease is an important cause of mortality as well as morbidity all over the world. Cirrhosis causes clinical manifestations extending beyond the liver. In patients with chronic liver disease, the cause of mortality is usually related to the liver pathology, but extrahepatic manifestations of chronic liver damage contribute significantly to the morbidity. With regards to the cardiovascular system, the manifestations are due to circulatory disturbances and cardiac dysfunction. Among all etiologies, cirrhotic cardiomyopathy is the cardiac dysfunction secondary to chronic liver disease. Objective: To study the echocardiographic abnormalities in patients with chronic liver disease. Materials and Methods: This was a cross-sectional study that was conducted on 80 patients in a tertiary care center. All etiologies for chronic liver disease were included. The diagnosis was confirmed by clinical features, laboratory and imaging criteria, and endoscopic evidence, and the duration of the abnormalities was to be persistent for more than six months. Echocardiography was done within one week of conducting the investigations. Echocardiography was done by the same cardiologist, who was a part of the study group, for all the patients. Results: The study cohort included 69 males and 11 females. The age ranged from 36 years to 76 years. The most common abnormality noted was left ventricular hypertrophy 48 (60%). Diastolic dysfunction was observed in 33 (41.5%). The other abnormalities noted include: left ventricular dilatation 5 (6.25%), dilated left atrium 13 (16.25%), increase in pulmonary artery pressure 15 (18.75%), and right ventricular dysfunction 10 (12.5%). Conclusion: Cirrhotic cardiomyopathy is a common but silent entity. A high index of suspicion is to be kept for this entity while managing patients with cirrhosis. The existence of this entity, if known, will be helpful in the management of patients during procedures or diseases that place stress on the heart. The use of newer modalities of imaging such as tissue Doppler imaging and two-dimensional speckle tracking echocardiography is more sensitive than conventional echocardiography for identifying cardiac dysfunction.
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A hospital-based cross-sectional study for assessment of immunization status of children in western Maharashtra, India p. 390
Vaishali Praful Bansod, Maya Nilesh Nannaware, Shraddha Shripad Kulkarni, Harishchandra Dyanoba Gore, Shubhangi Uttam Agawane, Parvinder Singh Chawla, Khyati Gagan Kalra
DOI:10.4103/mgmj.mgmj_71_21  
Background: Immunization against vaccine-preventable diseases is a fundamental right of children and a way to reduce childhood mortality and morbidity; thus, it is a way to improve the health of the community. Delayed vaccination increases the susceptibility of a child to vaccine-preventable diseases and also affects herd immunity. So this study was undertaken to assess the immunization status of children attending a tertiary care hospital that caters to urban as well as rural populations, focusing on the timeliness of vaccination, and to explore the predictors of vaccination delay. Materials and Methods: A cross-sectional study was carried out among 302 immunization attendees of 12–23 months of age in the immunization outpatient department of a tertiary care hospital. Parents were interviewed, and vaccination dates were obtained from vaccination cards and assessed for vaccination delay. Results: From a total of 302 children of age 12 to 23 months who enrolled in the study, 165 (54.64%) children were vaccinated on time and 137 (45.36%) children had vaccination delays. When assessing vaccination delay, 24 (7.95%), 44 (14.57%), and 118 (39.07%) children were found to have vaccination delay for Bacille Calmette-Guerin (BCG), pentavalent vaccine (PENTA1), and magnetic resonance imaging (MR1), respectively. Out of them, 49 (16.22%) children had vaccination delay for more than one vaccine. Age at first pregnancy, place of delivery, gender, birth order, and birth weight of the child were found to be statistically significant for delayed vaccination. Conclusion: Delays in vaccination can be addressed by offering mobile vaccination clinic facilities to migrant people as well as raising community knowledge about the importance of timely child vaccination through the targeted approach: Information, Education, and Communication (IEC) activities.
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Perceptions of married women about reasons and suggested solutions regarding gender preferences for offspring in Katputli Nagar, Jaipur: a cross-sectional study p. 398
Vivek Bharti, Suresh Kewalramani, Amita Kashyap, Priyanka Kapoor
DOI:10.4103/mgmj.mgmj_58_21  
Background: In India, the preference for a son is strong. Due to many reasons in various communities, the strong desire for a son and discrimination against a female child are causing the non-preference of female children, resulting in a skewed sex ratio in India. The main objective of the study was to assess the perception of urban slum married women in the reproductive age group about reasons and solutions to overcome gender preference. Materials and Methods: A community-based cross-sectional study on 1230 married women of urban slums of age group 15–49 years was carried out in Katputli Nagar in Rajasthan state, India. Information regarding reasons and solutions to overcome gender preference was asked. A predesigned semi-structured questionnaire was used for data collection. Results: Out of the 1230 study subjects, the majority reason for the male preference was “propagation of family name” (53.3%), followed by “family safety” (46.5%) and “funeral responsibility” (44.8%), “financial help in future” (39.2%) and “old age support” (40.2%). “Family name spoilage if remaining unmarried” and “female offspring will not stay with them after marriage” were the most preferred reasons for female non-preference (59.8% and 58.3%), respectively, and “dowry” in 56.4%. Strict implementation of anti-dowry law and better implementation of educational aids for girl child might be strong changes (69.83% and 69.18%, respectively), followed by “improvement in the security of females” (61.95%). Conclusion: Propagation of family names was an important reason for the preference for males. Strict implementation of anti-dowry law and better implementation of educational aid for female children might be strong changes that could remove gender discrimination in society.
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Ocular manifestation of pregnancy-induced hypertension p. 403
Sheetal Devaru, Kalpana Badami Nagaraj, Snehal Himmatlal Shah
DOI:10.4103/mgmj.mgmj_56_21  
Background and Objectives: Pregnancy-induced hypertension (PIH) is a challenging obstetric condition that can result in grave complications. The retina is a unique site where the vasculature in the human body is visualized directly with the help of an ophthalmoscope. Progression of retinal changes generally correlates with the progression of PIH. The purpose of this study was to determine the prevalence and association of retinal changes with the progression of PIH. Materials and Methods: This is a hospital-based, prospective, observational study. A total of 100 admitted cases diagnosed with PIH was included in the study. Ocular and systemic history, age, blood pressure, and proteinuria were noted. A dilated indirect ophthalmic examination was done at the bedside of the patient. Results: A total of 100 patients with PIH were examined. The mean age of the patients was 24.8 years; the mean gestational age was 36.5 weeks. Out of the total 100 patients with PIH who were examined, retinal changes were noted in 43 patients. The prevalence of retinopathy changes was more pronounced among patients with severe preeclampsia (76.5%) and eclampsia (88.9%). As the severity of the PIH increased, the odds of women developing retinopathy also increased substantially and this association between the severity of PIH and the development of retinopathy changes was found to be statistically significant. A significant correlation was also seen between albuminuria and the severity of retinopathy. Conclusion: Cases of severe preeclampsia and eclampsia showed higher grades of retinal changes. Thus fundus examination plays an important role in assessing the severity of PIH.
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A retrospective study on the prevalence of weak D antigen (Du) in a blood bank in a tertiary care hospital in Maharashtra, India p. 410
Abhiniti Rahul Srivastava, Sweta Wasudeo Dhote, Iqbal Singh
DOI:10.4103/mgmj.mgmj_77_21  
Background: One of the most immunogenic blood groups known to humans is the Rhesus (Rh) blood group. The Rh blood group with variable expression of D antigen is one of the complex systems in immunohematology. Sometimes, the variable expression of RhD antigen leads to the presence of weaker forms that are not detected by routine laboratory procedures. Aims: The study was conducted to determine the frequency of RhD negativity and weak D antigens. Settings and Design: This retrospective study was conducted in the Department of Immunohematology and Transfusion Medicine at a tertiary care center hospital for three years from June 2017 to June 2020. Materials and Methods: All the serial Rh grouping tests were conducted by the gel technique or by the tube method with two Anti-D reagents. Negative D antigen samples were further tested for weak D antigen by Coombs Test. Statistical analysis used the Statistical Package for Social Sciences (SPSS). Results: Out of a total of 17262 samples, 15400 (89.2%) tested Rh-positive, and 1866 (10.8%) tested Rh-negative. Weak D was positive in 52(0.027%) samples out of the RhD negative samples. Conclusion: The frequency of weak D antigen is low, but the strong immunogenicity of RhD antigen calls for the need for appropriate testing. This is of concern in RhD negative pregnant females, as it can cause alloimmunization if accidentally weak D antigen-positive blood is transfused.
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Antibiofilm activity of selenium nanorods against multidrug-resistant staphylococcus aureus p. 415
Shweta Hasani, Tushar Khare, Uttara Oak
DOI:10.4103/mgmj.mgmj_35_21  
Objective: This study aimed at the synthesis and application of selenium nanoparticles (SeNPs) against biofilm formation by multidrug-resistant (MDR) Staphylococcus aureus isolated from the domestic sewage treatment plant. Materials and Methods: Chemically synthesized SeNPs were characterized using Ultraviolet–visible spectroscopy, X-ray diffraction, and high resolution scanning electron microscopy (HR-SEM).. Bacteria were isolated from domestic sewage water samples and characterized and identified using standard techniques. The drug resistance pattern of the isolates was determined using a disk diffusion assay. Biofilms of this MDR isolate were established (microtiter plate method—colorimetric assay and a slide method). Minimum inhibitory concentrations (MIC) of selenium nanorods (SeNRs) and their effect on biofilm formation were established using a colorimetric method. Results: The HR-SEM analysis of nanomaterials revealed its shape (rod), size (between 85 nm and 275 nm), and purity of the material. The disk diffusion assay attributed MDR status to an isolate that was identified and found to be S. aureus, a pathogenic bacterium isolated from an environmental sample. The MICs of antibiotics against biofilm were found to be at least threefold higher than those against the planktonic state. In the presence of SeNRs, biofilm formation was inhibited. Conclusion: SeNRs synthesized using wet chemical method showed antibacterial activity against MDR S. aureus and inhibited biofilm formation by this organism. These SeNRs can be further developed as an alternate drug lead to combat the challenge posed by the MDR bacteria. The study has a future prospectus in investigating the mechanism of inhibition of biofilm formation and its action on preformed biofilm by this isolate.
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REVIEW ARTICLES Top

Global efforts on vaccines development against SARS-CoV-2 and Indian endeavor p. 422
Prasanta Kumar Ghosh
DOI:10.4103/mgmj.mgmj_85_21  
By the end of September 2021, worldwide there were 22 approved SARS-CoV-2 vaccines of which nine were inactivated whole virus-based, six were replication-deficient viral vectored, four protein subunit based, one DNA vaccine, and two mRNA vaccines. Developmental efforts were also to manufacture the whole virus attenuated vaccines, viral vector replicating vaccines, bacterial vector-based vaccines, and viral particle-based vaccines. Host-cell-based vaccines were also being explored. As of October 05, 2021, there were 318 novel vaccine development approaches of which124 had entered into the clinical development stage, the rest 194 were in the preclinical stage. As of October 22, 2021, there were 243.44 million COVID-19 patients worldwide, of which 220.6 million recovered, and about 4.95 million died. The largest deaths per one million population were recorded at 5659 in Peru, and the smallest of 3 were in China. The total vaccine doses deployed worldwide were 6795 million, with 38% of the world population fully vaccinated, and 50% partly. India had taken multiple proactive steps, which included the development of local capabilities in various aspects including manufacturing of vaccines, testing methods and devices development, mass vaccination, mass testing, and production of personal protective equipment and materials. India had lost 324 people per one million, which was much lower than those witnessed in several countries like the Czech Republic, Brazil, Argentina, Spain, Columbia, Romania, the USA, Belgium, Mexico, and Italy. The virus is anticipated to stay in nature and people would have to live with it. Mass vaccination of people all over the world as fast as possible, and deploying booster doses on vulnerable people including those aged 60 years and above, are thought to be most protective for the people against the disease.
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Poincare plot: A simple and powerful expression of physiological variability p. 435
Sushma N Bhat, Ghanshyam D Jindal, Monica Xavier, Raj D Wagh, Kajal S Garje, Gajanan D Nagare
DOI:10.4103/mgmj.mgmj_88_21  
“Variability is the sign of life” is the principle being followed by all living beings on the earth. The study of variability came into existence in 1965 with Hon and Lee’s observation of the need for rapid delivery after a decrease in fetal heart rate variation. The field has grown phenomenally since then and has become an essential part of patient care. Heart rate variability is the most studied and explored for its physiological origin and subsequent clinical applications. It has been followed by blood pressure variability, blood flow variability, morphology index variability, and so on. These variabilities are expressed in the time domain, frequency domain, and nonlinear domain by different parameters and geometric shapes. Poincare representation is one of the nonlinear domain representations of variability. Elliptical, torpedo-like, or fan-shaped central conglomeration of points in Poincare plots are generally considered normal. The shape distorts considerably in different diseases. Not much effort has been made to classify these distortions since the time domain and frequency domain presentations have dominated most of the studies due to their numerical expression. Poincare presentation in arrhythmias is very interesting to the extent that a diagnosis can be made based on the Poincare plot. The point plots are now being extended to curve plots or line plots for better detection of arrhythmia and its understanding. Owing to large scatter in the time domain and frequency domain parameters of variability, extended Poincare plots are currently being explored as substitutes. Some of these features of Poincare plots and their clinical applications are briefly described in this article.
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CASE REPORTS Top

Hemifacial microsomia and bilateral Mondini dysplasia: A rare clinical presentation p. 442
Padma Ramesh, Vaishali Sangole, Aathira Neelikattu
DOI:10.4103/mgmj.mgmj_44_21  
We present a rare association of bilateral Mondini dysplasia with hemifacial microsomia (HFM). HFM is a clinical spectrum of malformations involving the orbit, mandible, ears, facial nerve, and soft tissues of the face. It occurs in about 1 in 5600 births and requires a multidisciplinary approach to management.[1] We report a case of HFM in an 11-year-old girl who presented with recurrent discharge from the nasal dorsum, and facial asymmetry since birth but was otherwise asymptomatic. The hearing evaluation revealed bilateral sensorineural hearing loss. High-resolution computed tomography scan of the temporal bones showed bilateral Mondini dysplasia of the inner ear which to the best of our knowledge has not been previously reported in HFM. We conclude that all cases of HFM regardless of symptomatology should undergo hearing evaluation. This will facilitate rehabilitation of deafness if present.
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Boerhaave’s syndrome in a sixty-two-year-old Nigerian man: delayed diagnosis secondary to premorbid symptomatology p. 446
Taamaka D Ngubor, Tomiwa Omokore, Nwachukwu O Nwachukwu, Peter K Uduagbamen
DOI:10.4103/mgmj.mgmj_40_21  
Boerhaave’s syndrome is a rare spontaneous transmural esophageal rupture from forceful vomiting. It is commonly misdiagnosed either from the non-specific presentation or its mimicking known premorbid conditions. Mortality could be very high and early with delayed diagnosis. We present a rare occurrence of this syndrome in which delayed diagnosis was due to premorbid conditions of bronchial asthma and hypertension and not symptom presentation and with a very good treatment outcome.
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Hydropic placenta in a case of malaria p. 449
Prema Saldanha
DOI:10.4103/mgmj.mgmj_93_21  
Malarial infection can be life-threatening to both the mother and the developing fetus. The placenta can show various histological changes, and the presence of mature parasites or malarial pigment in the placenta is necessary to define placental malaria. This is a case of a 28-year-old multigravida who presented with malaria and was found to have a hydropic fetus on ultrasonography. Hydropic change has not been reported so far in placental malaria.
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PERSPECTIVE ARTICLE Top

Hypothesized biological mechanisms by which exercise-induced irisin mitigates tumor proliferation and improves cancer treatment outcomes p. 452
Chidiebere Emmanuel Okechukwu, Chidubem Ekpereamaka Okechukwu, Ayman Agag, Naufal Naushad, Sami Abbas, Abdalla Ali Deb
DOI:10.4103/mgmj.mgmj_67_21  
Exercise has been linked to a significant decrease in cancer pathogenesis. Irisin is an exercise-induced myokine that is released from the skeletal muscle upon cleavage of the membrane of fibronectin type III domain-containing protein 5. Exercise has been revealed to raise irisin concentration in the blood and muscle cells via the upregulation of peroxisome proliferator receptor γ coactivator-1α expression. Exercise-induced irisin reduces the risk of numerous cancers by burning excess body fat. We hypothesized that exercise-induced irisin may mitigate tumor proliferation by inducing apoptosis and improving cancer treatment outcomes via modulating several signaling and metabolic pathways, mainly by increasing the phosphorylation of adenosine monophosphate-activated protein kinase and acetyl-CoA-carboxylase, via deactivating the phosphatidylinositol 3-kinase/protein kinase B Snail signaling pathway, by upregulating the apoptosis pathway through the inhibition of epithelial–mesenchymal transition and via stimulating caspase activity.
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SHORT COMMUNICATION Top

Hookah smoking and COVID-19 in India: Fan the Flames p. 459
Ryan Varghese, Jainam Karsiya, Prasanna R Deshpande
DOI:10.4103/mgmj.mgmj_63_21  
In recent years, hookah smoking has gained popularity in India, especially among youth. However, its abuse increases the risk of COVID-19. The present letter discusses the harmful effects of hookah smoking, international policies for the cessation of hookah smoking, and the pressing need to have policies to mitigate hookah use and curb the spread of COVID-19 in India.
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