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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 8 | Issue 3
Page Nos. 199-320

Online since Friday, September 3, 2021

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EDITORIAL  

COVID-19 pandemic and the vaccines in the year 2021: Current issues Highly accessed article p. 199
Sushil Kumar
DOI:10.4103/mgmj.mgmj_53_21  
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ORIGINAL ARTICLES Top

Venous lactate level as a predictor to determine the outcome in patients with acute upper gastrointestinal hemorrhage in the emergency department Highly accessed article p. 203
Nitesh Kumar, Diwakar Verma, Kapil Gupta, Madhu Kiran, Shatrughan Pareek, Mahish Mehta
DOI:10.4103/mgmj.mgmj_19_21  
Introduction: Gastrointestinal bleeding (GIB) is occasionally seen in various clinical conditions in emergency departments (EDs). It is associated with more disease burden and mortality. Most severe patients with upper GIB (UGIB) have an increased level of lactate, whereas it is still not considering a risk predictor among the patients. The present study aimed to evaluate several levels and a cut-off value of lactate for predicting outcomes of patients with UGIB. Materials and Methods: The present cross-sectional observational prospective study was conducted in the ED of Max Hospital, Saket, New Delhi, over a study period of 18 months from June 2015 to December 2016. The participants selected for the study were more than 17 years old from both genders with UGIB. In the study, 300 subjects were selected by the convenient sampling method. All the analyses was done by SPSS-20. Results: In this study, male and female subjects were 75.7% and 24.3%, respectively. Nearly 25% of the participants were hypertensive and diabetic. The study highlighted that the mean lactate level was 4.55±2.45 mmol/L; however, the range of the lactate level was 1.4–14. Based on the receiver operating characteristic curve analysis, the optimum cutoff of lactate was 4.55 mmol/L, had an area under the curve of 0.905 (confidence interval: 0.861–0.949), sensitivity of 80.5%, specificity of 98.9%, and P-value of less than 0.05. Likewise, the results of this study also communicated that there was a significant positive correlation (P-value = 0.001*) between the level of lactate and the outcome of the patients. The present study also discriminated that venous lactate levels 4.55 mmol/L and above are associated with mortality and hospital stay. Conclusion: Findings of this research study suggested that venous lactate level is an effective predictor of patient outcome among patients with UGIB. Furthermore, early assessment and management are needed to reduced mortality and morbidity among patients with UGIB.
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Evaluation of pediatric prescriptions using WHO indicators in a tertiary care hospital in Pune city, India Highly accessed article p. 210
Alitta Prasad, Apoorv Johar, Prasanna R Deshpande
DOI:10.4103/mgmj.mgmj_23_21  
Context: The study provides comprehensive insight on the use of World Health Organization (WHO) prescribing indicators in the pediatric population in a tertiary care hospital. Aims: The aim was to evaluate pediatric prescriptions as per WHO prescribing indicators. Settings and Design: This study was a prospective observational study, conducted at Pediatrics Outpatient Department (OPD) of a tertiary care hospital for 6 months. Materials and Methods: This included consent form and data collection form. Statistical Analysis: Spearman’s rank correlation and Mann–Whitney U-test were performed to evaluate whether prescribing indicators are statistically dependent on age and gender, respectively. P-values less than 0.05 were considered to be statistically significant. Results: A total of 418 prescriptions were included in the study. The majority of the patients were female (70.09%). The mean age of the patients was 5.87 (SD±4.32) years, with a range from 3 days to 17 years. The average number of drugs per prescription was 2.4 (SD±1.022). Only 4.21% of medicines were prescribed by generic name. Antibiotics and injections were prescribed in 7.65% and 0.23% of prescriptions, respectively. Drugs prescribed from the essential drug list (EDL) were 60.45%. Conclusion: The study necessitates the need to follow the optimal values set by WHO prescribing indicators. The percentage of prescriptions with antibiotics and injections was in the optimal range as set by WHO. However, the average number of drugs/prescriptions, usage of generic names, and prescriptions using the EDL were not in the optimal range. The prescribing indicator did not statistically depend on age and gender.
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Spectrum of endometrial pathology in patients with abnormal uterine bleeding: a rural population experience p. 216
Abeer M Ilyas, Mohd Abbas Ilyas, Abida M Ilyas, Siddique S Kamal Pasha, Ajay Kumar
DOI:10.4103/mgmj.mgmj_33_21  
Introduction: Abnormal uterine bleeding (AUB) is one of the most common problems among women of all age groups. Endometrial sampling is a frequently performed procedure by the gynecologist that offers an opportunity to diagnose pathological conditions in the endometrium to accurately evaluate and diagnose the etiology. A study of the endometrium will establish the underlying cause and thereafter help the gynecologist to plan for the management. Aims: To study the histopathological pattern and spectrum of lesions in a patient with AUB. To analyze various pathological conditions and to highlight the importance of endometrial histology. Materials and Methods: This is a retrospective study that evaluated 83 patients with AUB by dilatation and curettage and/or endometrial biopsy of the rural population. Results: The most common endometrial pattern found to be hyperplasia without atypia (19/83) 22.9% followed by disordered proliferative (17/83) 19.27% and later by endometrial polyp (8/83) 9.63%, atypical hyperplasia/endometrioid intraepithelial neoplasia (1/83) 1.2% and lastly one case each of chronic non-specific endometritis, tuberculous endometritis, and histiocytic endometritis. There were 2/83 that is 2.4% case of endometrial adenocarcinoma with age range falling between above 50 years. Conclusion: Endometrial biopsy or curettage could be a safe and effective diagnostic step in the evaluation of AUB after ruling out medical causes with a detailed workup of the patient. This could help the clinician to design therapy for successful management.
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A comparative evaluation of Typhidot and Widal tests for the detection of agglutinins against typhoid and paratyphoid bacilli in patients’ sera p. 222
Raksha Singh, Gurjeet Singh
DOI:10.4103/mgmj.mgmj_57_21  
Background: The term enteric fever includes typhoid fever caused by Salmonella typhi and paratyphoid fever caused by Salmonella paratyphi A, B, and C. Typhoid fever has been virtually eliminated in the developed countries during the past several decades, mainly as a result of improvement in water supply and sanitation, but it continues to be endemic in the resource-limited nations of the world. The control of paratyphoid fever has not been so successful. Bacteriological diagnosis of enteric fever consists of isolation of the bacilli from the patients and the demonstration of antibodies in their sera. Widal testing is cost-effective and gives reports quickly. The Typhidot test is based on the method of immunochromatography test. It is easy to perform, and the results can be preserved for a long time. This study aims to compare the sensitivity and specificity of the Widal test and Typhidot test for the diagnosis of enteric fever. Materials and Methods: This prospective study was carried out at the Department of Microbiology, N.C. Medical College and Hospital, Panipat, Haryana, India, over 6 months from September 2020 to February 2021. In our study, a total of 150 clinically suspected patients were included. First of all, the area for blood collection was cleaned with spirit-soaked cotton and 10 mL of blood was collected with a sterile disposable needle and syringe from a median cubital vein (antecubital vein) of each patient after obtaining informed consent from the patient (from parents in case of age below 18 years). Seven milliliters of blood was immediately transferred to a blood culture bottle by cleaning the cap of the bottle for isolation and identification of causative organisms and 3 mL was transferred to a sterile plain vial for serum separation. Then the qualitative Widal slide agglutination test and Typhidot test were performed on each sample. Results: In the present study, out of the 150 clinically suspected enteric fever cases, maximum positivity 53 (35.33%) was given by the Typhidot test, followed by 36 (24%) given by the qualitative Widal slide agglutination test and 44 (29.33%) given by blood culture for S. typhi and S. paratyphi. Conclusion: Our study highlights the use of Typhidot for early diagnosis of enteric fever and also cross-checks with Widal test and blood culture for the diagnosis of enteric fever. Typhidot tests are easy to perform and less-trained personnel can also perform the test; they have been designed to detect IgM and IgG antibodies to lipopolysaccharide or outer membrane protein antigens of S. typhi and S. paratyphi. It can be useful in the early diagnosis of infection in the initial weeks of primary infection when a single serum sample is available, with a sensitivity and specificity of 90% and 80%, respectively, considering blood culture as a gold standard.
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Impact of under-five mortality on economic growth and health-care expenditures in India p. 227
Saravanan Chinnaiyan, Bhavya Babu, Ananta Ghimire
DOI:10.4103/mgmj.mgmj_6_21  
Introduction: Under-five mortalities are the significant vital indicators of the population health condition and the social development of the country. Child survival is measured by the under-five mortality rate (U5MR). It also reflects the social, economic, and environmental circumstances, as well as their health care. Our main objective is to determine the impact of the U5MR on economic growth changes and health-care expenditure and examine the sex difference trend of under-five mortalities. Materials and Methods: We have retrieved data from World Bank Indicators from 2005 to 2017, with under-five mortality as the independent variable and health expenditure as a dependent variable. We used correlation analysis to assess the impact of under-five mortalities on economic growth and health-care expenditure in Rstudio (open-source software). Results: The U5MR was higher in females than in males. The correlation of mortality rate, under-five (per 1000 live births) with current health expenditure per capita, domestic general government health expenditure per capita, and domestic private health expenditure per capita was found to be statistically significant (P < 0.05). Conclusion: Accordingly, political stability, effective social sector policies, and government interventions are essential for reducing under-five mortality. The human health force’s participation in macro and micro policy-making is also necessary, and other determinants of health-care expenses should be critically examined.
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Novel method of tuboplasty using a thread stent: possibility to increase the success rate p. 232
Anuradha Palnitkar, Devdatt Palnitkar
DOI:10.4103/mgmj.mgmj_27_21  
Background: Women who have undergone tubectomy for sterilization seek reversal of sterilization for various reasons. The success rate of the traditional method used for recanalization has been compared to our novel method of using a stent. Objective: The aim of this article is to evaluate the success rate of a novel method of tuboplasty using a threaded stent. Materials and Methods: Twenty-one tuboplasty surgeries for reversal of sterilization done at our center were reviewed. All the patients underwent open abdominal tuboplasty using 4× Loupes for magnification. 6-0 Prolene (Johnson & Johnson) suture was used for tubotubal anastomosis with seromuscular sutures. In 11 patients operated on after the year 2010, a 1-0 Ethilon (Johnson & Johnson) thread was used as a “stent.” Before the year 2010, we used to do the anastomosis similarly but without a stent. Eight such patients operated upon before 2010 without stent were evaluated. Two patients operated upon after 2010, in whom the stent could not be placed satisfactorily, were also included in this group of unstented patients. Results: Of the 11 patients who could be stented successfully, 8 (72.7%) conceived a uterine pregnancy. Two patients (18.2%) from the stented group did not conceive. From the group of patients who were not stented or could not be stented (n = 10), only two (20%) conceived. Conclusion: Our novel method of tuboplasty using a thread stent can improve the pregnancy rate to 72.7%.
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Knowledge and awareness of ethics among phase 1 medical students: appraising the role of the foundation course p. 236
Jaspreet K Sidhu, Deepti Chopra, Bharti Bhandari, Surjit Singh, Jayant Rai
DOI:10.4103/mgmj.mgmj_25_21  
Background: The increasing incidence of disconnect between doctors and patients in India makes it imperative to teach principles and practice of ethics to medical graduates before they move into substantive clinical practices. The competency-based medical education (CBME) curriculum was recently introduced in India. The CBME curriculum encompasses teaching ethics at the beginning of the undergraduate medical curriculum. The study was planned to assess the knowledge and awareness of ethics among first-year undergraduate medical students at the beginning of the foundation course and after 40h of ethics training during the course. Materials and Methods: A standard 35-item questionnaire was administered to the first-year medical students at the beginning of the foundation course and after 40h of ethics training/teaching scattered throughout the foundation course. No personal information was recorded on the questionnaire to ensure the confidentiality and anonymity of participants. Results: There was a significant increase in the knowledge regarding some of the items in the questionnaire, such as “patient’s wishes must always be adhered to,” “if the patient refuses to be treated on religious grounds, they should be instructed to find another doctor.” Similarly, there was an improvement in the students’ knowledge of the practice of ethics. The students generally agreed that an awareness of ethics is important and should be an integral part of the MBBS curriculum. Conclusion: To prevent ethical erosion, ethics education should be introduced early during the undergraduate years, and continuous reinforcement is vital. We should strive to promote discussions about real occurrences directly involving students.
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Grassroots sexual and reproductive rights interventions on sexual risk behavior among female sex workers in Nigeria p. 244
Bartholomew B Ochonye, Paul O Abiodun, Felix O Sanni, Olufunke Tewobola, Tolu A Alamu, Ngozika Ogbonna
DOI:10.4103/mgmj.mgmj_42_21  
Introduction: Sexual reproductive health and rights (SRHR) involve access to accurate information, rights-based quality, safe, effective, affordable, and acceptable health-care services at all levels that cover the sexual and reproductive needs of the individual and community irrespective of social, sex, gender, and other differences. Objective: This study aims at assessing the grassroots interventions on the knowledge of rights, access, and uptake of sexual reproductive health (SRH) services among female sex workers (FSWs) in Benue State, Nigeria. Materials and Methods: This cross-sectional survey is a randomized cluster sampling among FSWs in Benue State, Nigeria. A structured questionnaire was used to collect data from the respondents, and the data collected were analyzed using IBM-SPSS Corp., Armonk, NY, version 25.0. The statistical significance level was set at P < 0.05. Results: Respondents were 446 FSWs aged 15–45 years, comprising 223 FSWs at baseline and post-intervention. Significantly higher intervention respondents (84.4%) use condoms while drunk compared with 56.1% at the baseline (P < 0.0001). Overall, 70.0% used lubricants in the past 12 months in the post-intervention study, whereas only 47.5% used them in the baseline study (P < 0.0001). Generally, 21.1% indulged in anal sex, and there was no significant difference between the baseline and intervention (P > 0.05). Virtually all respondents (96.0%) used any contraceptive methods in the intervention period compared with 68.6% at the baseline (P < 0.001). The intervention respondents were 11.84 (95% CI: 4.98–28.16; P < 0.0001) times more likely to use any contraceptive method than their baseline counterparts. The intervention respondents were 2.22 (95% CI: 1.51–3.27; P < 0.0001) times more likely to use emergency contraceptives than their baseline counterparts. Conclusion: This study showed the positive outcomes of grassroots interventions involving FSWs in Benue State, Nigeria. Such interventions should be extended to other key populations in Nigeria.
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To compare the efficacy of oral terbinafine alone against the combination of oral terbinafine and intense pulsed light (IPL) in difficult to treat tinea patients p. 253
Suraj Pawar, Ashish R Deshmukh
DOI:10.4103/mgmj.mgmj_95_20  
Background: Dermatophytosis is a major health problem in developing countries, with their increase in resistance patterns toward various antifungals being the main reason for concern. Aim: To compare the efficacy of oral terbinafine alone against the combination of oral terbinafine and intense pulsed light (IPL) in difficult-to-treat patients with tinea. Materials and Methods: Patients were divided into two groups, A and B. Group A was given oral terbinafine  mg twice a day for two months. Group B was given oral terbinafine  mg twice a day and IPL once every 15 days for a total of two months. Patients were assessed every 15 days till two months and every one month for three months after the completion of treatment for any recurrences. Results: Among group A, out of 40 patients, 32 patients showed complete cure while only 8 showed a partial cure. Among group B, out of 40 patients, 28 patients showed complete cure while 12 showed a partial cure. Recurrence among group A was 9 patients at the end of 5 months while it was 11 in group B. Conclusion: Even though there is no statistically significant difference between the cure rate of both the groups, terbinafine alone is found to be superior clinically.
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Altered leukogram and hematological parameters among leukemia patients p. 263
Andrew Nuhu Yashim, Dorcas Yetunde Obazee, Olumide Faith Ajani, Opeyemi Matthew Adewole, Collins Swem, Paul Olaiya Abiodun, Olaniyi Felix Sanni
DOI:10.4103/mgmj.mgmj_24_21  
Background: The incidence of leukemia is increasing in developing countries, particularly in Africa. Cancer-associated inflammation is a significant factor in the improvement and survival of people with cancer. This study aimed to evaluate changes in leukogram and other hematological parameters among leukemia patients in Abuja, Nigeria. Materials and Methods: The study comprised 30 leukemia patients attending the Oncology Department of National Hospital Abuja, Nigeria, from July 2019 to August 2020, and 20 healthy people. Three milliliters of blood was collected from each participant into an ethylene diamine tetra-acetic acid bottle and analyzed for full blood and differential counts using the Mythic 22 (Orphee, Switzerland) five-part differential hematology analyzer. CD4 and CD8 T cells were analyzed by flow cytometry. Data analysis was done using IBM-SPSS software, SPSS Inc., Chicago, IL, version 25.0. T-test was used to compare means between groups, and the significant value was set as P < 0.05. Results: All hematological parameters were significantly lower (P < 0.05) in leukemia patients than those in controls except for monocytes and basophils. In addition, white blood cell count was significantly higher in leukemia patients (13.0 ± 0.57 × 109/L) than that in controls (6.11 ± 1.14 × 109/L) (P < 0.05). CD4 (775.40 ± 82.91 cells/µL) and CD8 counts (634.40 ± 101.43 cells/µL) were significantly higher in controls than those in leukemia patients. Furthermore, CD4/CD8 ratio was significantly higher (P < 0.05) among controls (1.24 ± 0.15) than that in leukemia patients (1.17 ± 0.09). Conclusion: The study found that changes in hematological parameters and leukogram are significantly associated with leukemia. The use of therapies to boost immune response in patients with leukemia is recommended.
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Cost of medical management of patients in intensive care unit in a tertiary care teaching hospital, Pune, India p. 268
Achsah Anna Mathew, Jainam Narendra Karsiya, Neel Kiran Patel, Dharmik Anil Limbachiya, Jignesh Navinchandra Shah, Atmaram P Pawar, Prasanna R Deshpande
DOI:10.4103/mgmj.mgmj_31_21  
Aims and Objectives: The aim of this study was to assess the cost of illness of the patients admitted to the intensive care unit (ICU). Materials and Methods: A prospective observational study was conducted on patients admitted and discharged from ICU above 18 years of any medical illness for 6 months in ICU in a tertiary care teaching hospital, Pune. Data such as demographic details, diagnosis, disease class, cost of drug therapy, and medical care cost were obtained. The cost was analyzed using the bottom-up method and statistical analysis of data was done using Pearson’s correlation coefficient and Mann–Whitney U test. Results: Of 400 patients, the average age was 54.27 years with a length of stay of 3.69 days and mortality rate of 12.25%. The average total cost per patient accounted for Rs. 52,840 and the per day cost was Rs. 14,319. Amongst various diagnoses, the cost incurred in alcoholic liver disease (ALD) accounted for Rs. 75,060 of the total cost, whereas the average per day cost observed in myocardial infarction (MI) was Rs. 15,495. The cost of drug therapy per patient was Rs. 5204.33 and total drug therapy accounted for 12.08%. The average number of drugs prescribed per patient was 8.44. Antimicrobial costs were observed as 28% of the total cost. The cost of antimicrobials was Rs. 1473 per patient. Medical care costs, including consultant and investigation charges per patient, were found to be Rs. 632 and Rs. 6861, respectively. Conclusion: The study reveals that ICU bed charges, miscellaneous charges, and drug therapy costs have more contribution to the direct medical cost of hospitalization.
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Analysis on discard of blood and blood components in a tertiary care center: a guide to blood inventory management p. 277
Shweta Wasudeo Dhote, Abhiniti Rahul Srivastava, Iqbal Singh
DOI:10.4103/mgmj.mgmj_39_21  
Introduction: In contemporary medicine management, it is evident that transfusion of blood and blood components has become an integral part of the patient. Human blood has no complete substitute to date. Blood is a perishable product and hence proper management of blood inventory is very crucial. Blood being a perishable commodity, efficient management of inventories is pivotal. The challenge that blood centers are facing is to keep sufficient stock to ensure an adequate supply of blood while minimizing losses. Aims and Objectives: The present study is designed to analyze various causes of discard of blood and blood components. Settings and Design: This is an analytical and retrospective type of study, carried out in the Department of Transfusion Medicine, from January 2019 to December 2019. Materials and Methods: Data were collected from blood bank records and confirmed from the master register. Data were then tabulated and analyzed. Statistical analysis used is as follows: Microsoft Excel database sheet was used for analyzing the results for the calculation of percentage and the χ2 test was used. Results: A total of 5,753 units were collected during the study period. A total of 13,913 components were prepared. Out of which, packed red cells (PRCs) were 5691, fresh frozen plasmas (FFPs) 5592, platelet concentrate (PC) 2531, and cryoprecipitate 99. The average discard rate for PRC, FFP, PC, and cryoprecipitate was 4.95%, 2.46%, 19.12%, and 3.03%, respectively. The most common reason for PRC and platelets discard was expiry followed by positivity for transfusion-transmitted infections (TTIs), whereas discard of FFPs was due to breakage in the case. Conclusion: The most common reason for the discard of PRCs and platelets in our study was expiry and positivity for TTI, whereas FFPs were mostly discarded due to breakage/leakage.
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Impact of Internet in school-going adolescents: a cross-sectional observational study p. 282
Shraddha Jadhav, Praveen Godara, Arun V Marwale, Gaurav P Murambikar, Deepanjali Deshmukh, Prince Garg
DOI:10.4103/mgmj.mgmj_38_21  
Introduction: Internet addiction is an online-related, compulsive behavior that interferes with normal living and causes severe stress on family, friends, loved ones, and one’s work environment. The addiction behavior becomes unmanageable, completely dominates the addict’s life, and impacts relationships and work. Aim: To identify the level of Internet addiction among school-going adolescents and its associated factors. Materials and Methods: A descriptive, cross-sectional study was conducted among school-going adolescents of age 13–19 years in Aurangabad, Maharashtra. Stratified random sampling was adopted, and 602 students were enrolled. Individual interview and Internet addiction test (IAT), a self-report 20-item tool for adolescents and adults, were used. The content validity and reliability of the tool were established, and a pilot study was conducted. Results: Approximately 19.77% of students had full control of his or her usage; 67.11% of students experience frequent problems because of excessive Internet use, and 13.12% of students had significant problems because of Internet use. About 99.8% had used the Internet before, and 61.0% had their devices such as laptops (59.1%), tablets (26.1%), and cell phones (4.0%). In total, 59.5% use the Internet for entertainment and 10.3% for relieving loneliness. There was a significant association between IAT outcome and age group such that with an increase in age developed the risk of getting Internet addiction (P = 0.003). Conclusion: We observed that 13.12% had significant problems because of Internet use. The factors significantly associated with IAT outcome were age group, medium of education, a device to access the Internet, and whether parents know about student’s Internet activities.
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REVIEW ARTICLES Top

Generation of efficacy data on 60 years and older population using SARS-CoV-2 vaccines p. 289
Prasanta Kumar Ghosh
DOI:10.4103/mgmj.mgmj_34_21  
As of March 31, 2021 nine vaccines against coronavirus-2019 disease (COVID-19 flu) were approved globally, which include ChAdOx1 (AZS1222) (AstraZeneca/Oxford, UK), COVAXIN (Bharat Biotech, India), BNT162b2 (Pfizer-BioNTech, USA), mRNA-1273 (Moderna, USA), ADENO 26 CoV2.S (Johnson &Johnson, USA), Sputnik V (Gamaleya Research Institute of Epidemiology and Microbiology, Moscow, Russia), CORONA VAC (Sinovac Biotech, China), BBIBP-Cor V (Sinopharm, China), and ZF2001 (Anhui Zhifei Longcom, China and Institute of Microbiology, China). All are two-dose vaccines except two, namely ADENO 26 CoV2.S that requires one dose only and ZF2001 that requires three doses. In India, during the same period, only two vaccines namely of AstraZeneca/Oxford by the name COVISHIELD in India, and COVAXIN of Bharat Biotech, Hyderabad were approved. As there is yet no effective therapeutic substance to contain the disease, mass vaccination is the only effective alternative to fight the pandemic. Due to the nonavailability of an adequate supply of ChAdOx1 (AZS1222) vaccine, countries using this one are resorting to delaying the use of the second dose, which must be deployed before the antibody titer is waned off after the first dose. There is a need to experimentally determine how much delay can be made between the two doses for other vaccines also. It was found later that AstraZeneca/Oxford vaccine provided protection after the first dose, up to 90 days, and therefore, the second dose was adopted to be used after 12 weeks. As people over 60 years are more vulnerable to the disease, data need to be generated for each vaccine on this population on whether there is any need to reschedule the dosage gaps as also if new three-dose regimens are more efficacious.
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Management of olfactory dysfunction in COVID-19 patients: a review p. 297
Santosh Kumar Swain
DOI:10.4103/mgmj.mgmj_37_21  
Coronavirus disease 2019 (COVID-19) is a highly contagious infection of the respiratory tract by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The symptomatology of COVID-19 varies from mild symptoms such as fever and dry cough to severe acute respiratory distress syndrome (ARDS). There is an increasing number of patients with anosmia and hyposmia as the COVID-19 pandemic continues. Currently, loss of smell is a well-recognized symptom of the COVID-19 infection, and some of the patients develop long-lasting olfactory dysfunction. Some COVID-19 patients may present with olfactory dysfunction as the only symptom or with other symptoms. The exact pathogenesis of olfactory dysfunctions is still not clear. The clinical evolution of the olfactory dysfunction in COVID-19 patients is still unclear as the recovery reports vary significantly. There is no recommended standard treatment protocol to reduce anosmia or hyposmia due to COVID-19 infection. A short course of oral corticosteroids and olfactory training (OT) is a safe and effective option for managing post-COVID olfactory dysfunction. The efficacy of intranasal corticosteroid spray is still in doubt for treating olfactory dysfunction in COVID-19 patients. Currently, OT is a useful treatment option for anosmia or hyposmia in COVID-19 patients. However, there is a crucial need for further studies to get better and more effective treatment options for a complete cure of the post-COVID-19 olfactory dysfunction. This review article discusses the details of the management of olfactory dysfunction in COVID-19 patients. The literature sources included PubMed, Scopus, Google Scholar, and Medline databases and searched with word management of olfactory dysfunction in COVID-19 patients, smell disturbances, COVID-19 infections, olfactory dysfunction, and medical treatment of olfactory dysfunction.
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CASE REPORTS Top

A classic case of ischemic central retinal vein occlusion with macular edema p. 303
Mani Kruthika Mantha, Tarun Kumar Suvvari, Lakshmoji Naidu Kotipalli, Tejaswi Kota
DOI:10.4103/mgmj.mgmj_13_21  
Central retinal vein occlusion (CRVO) is a significant cause of marked or total loss of vision in the middle-aged and elderly population. The patient was a 54-year-old man with a history of uncontrolled diabetes and was given seven intravitreal bevacizumab (Avastin) injections as treatment. The patient was advised to follow-up during the next 6 months, including gonioscopy and undilated examination of the iris to look for the iris/disc neovascularization. We presented a classic case of unilateral ischemic CRVO with macular edema, in whom diabetes is the leading risk factor. Close follow-up and diabetes control are advisable to prevent a similar scenario.
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Antenatal diagnosis and management of cystic hygroma with hydrops fetalis p. 308
Saloni Pugalia, Shruti Shetty, Sabrina Mhapankar
DOI:10.4103/mgmj.mgmj_28_21  
Cystic hygroma is a congenital thin-walled cyst that contains lymphatic fluids. Ultrasonography has helped in detecting more and more cases of cystic hygroma with fetal hydrops. Fetal hydrops and cystic hygroma can be diagnosed in the first and second trimesters of gestation and are associated with a higher incidence of aneuploidy and have higher mortality rate. The mortality rate of cystic hygroma diagnosed before 30 weeks is 93%, and 84% of those are associated with progressive non-immune hydrops. We present three case series of cystic hygroma progressing to hydrops fetalis.
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DRESS syndrome: a case report p. 312
Shreya Gudi, Tushar Kanti Biswas, Sriraj Kane
DOI:10.4103/mgmj.mgmj_29_21  
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare adverse drug reaction. We report a rare case of DRESS syndrome secondary to antitubercular treatment (ATT). A 65-year-old male patient with pulmonary tuberculosis (TB) presented with fever, cough and breathlessness, flushing of the face, and itchy erythematous maculopapular rashes over the abdomen, thorax, upper and lower extremities for 3 days, about 4 weeks after starting fixed-dose combination (FDC) of antitubercular drugs-intensive phase therapy as recommended under the Revised National TB Control Programme (RNTCP). Investigations revealed eosinophilia, severe thrombocytopenia, cholestatic hepatitis, and acute kidney injury (AKI) with metabolic acidosis. FDC was withheld and the patient was managed as DRESS syndrome fulfilling diagnostic criteria. The patient showed gradual improvement with progressive return of laboratory parameters towards normal levels. DRESS syndrome following ATT is very rare with fewer case reports from India. Physicians prescribing ATT need to be aware of this severe hypersensitivity reaction to anti-TB drugs.
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Neuropsychopathology of gambling disorder p. 317
Chidiebere Emmanuel Okechukwu
DOI:10.4103/mgmj.mgmj_32_21  
Gambling disorder (GD) is characterized by a pattern of continual or persistent gambling behavior, which may be online or offline, demonstrated by impaired control over gambling (e.g., inception, rate, passion, duration, cessation, and perspective). GD entails growing precedence given to gambling activities to the point that gambling takes priority over other daily activities and continuation and intensification of gambling despite the rate of negative consequences. The pattern of gambling behavior may be constant or episodic and recurrent. With regard to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, gambling behavior and associated characteristics are usually apparent over at least 12 months for a diagnosis to be assigned, although the required period may be reduced if all the diagnostic criteria are met and the symptoms are severe.
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