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   Table of Contents - Current issue
Coverpage
April-June 2022
Volume 9 | Issue 2
Page Nos. 133-262

Online since Friday, June 17, 2022

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EDITORIAL  

Doctors’ suicide and the vulnerability of medical profession Highly accessed article p. 133
Sushil Kumar, Vidya Ramanathan
DOI:10.4103/mgmj.mgmj_72_22  
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ORIGINAL ARTICLES Top

Estimation of maternal mortality ratio with sisterhood method in six local government areas of Oyo State, Nigeria p. 135
Ali J Onoja, Felix O Sanni, Simon P O Akogu, Sheila I Onoja, Imam Adamu, Yakubu O Yaaba
DOI:10.4103/mgmj.mgmj_80_21  
Background: The reduction of maternal mortality rate has been the top priority of global health, yet its persistently high rate in Africa is a severe issue that requires the attention of both the individual and policymakers. Objective: To determine the maternal mortality rate by applying the sisterhood method in six local government areas in Oyo State. Materials and Methods: The indirect sisterhood method was used to collect data concerning maternal mortality. For study purposes, the data were collected from women in the reproductive age group between 15 and 49 years using a structured questionnaire. Statistical Package for the Social Sciences version 25.0 software was used for analyzing the collected data. Results: It has been observed that the average maternal mortality rate in the six local government areas was 489/100,000 live births ranging from 346 to 756/100,000 live births. The highest maternal mortality rate was found in Iseyin local government area (756/100,000 live births), followed by 586/100,000 from Saki, 444 from Ibadan North, 430 from Ogbomosho, 374 from Atiba, and the least value of 346/100,000 live births in Ibadan North local government area. Conclusion: The maternal mortality rate has been found lower than the previous studies but still unacceptably high, especially among adolescents aged 15–39 years. Therefore, it is advocated that policymakers employ appropriate interventions such as the release of more funds for standard family planning and childbirth spacing programs to minimize maternal mortality in the state.
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Treatment outcomes of concurrent weekly cisplatin with intracavitary brachytherapy in patients with cervical carcinoma, pre-treated with concurrent chemo-radiotherapy p. 141
Swapan K Mallick, Asit R Deb, Gufran K Nahid
DOI:10.4103/mgmj.mgmj_9_22  
Objective: Cervical carcinoma is one of the leading causes of cancer-related deaths. This study evaluates improvement of quality of life, response to treatment, and compliance of concurrent weekly cisplatin with intracavitary brachytherapy (ICRT) in patients with cervical carcinoma, pre-treated with concurrent chemo-radiotherapy. Materials and Methods: This study was conducted in the Department of Radiotherapy, Government Medical College, from October 2018 to March 2020, meeting specified inclusion and exclusion criteria; patients willing to participate in the study were included. Results: On analyzing the pattern of response, 91.0% of patients have a complete response. The incidence of nausea and vomiting was observed at grade 1 or 2 in 80.0% of patients, grade 3 in 17.0% of patients, and more than grade 3 in 3.0% of patients. Neutropenia is occurred at less than grade 3 in 30.0% of patients and grade 3 or more in 3.3% of patients. Vaginal mucositis was also observed in 85.0% of the patients in less than grade 3 and 11.6% in grade 3 or more. The incidence of renal dysfunction less than grade 3 was seen in 35.0% of the patients and grade 3 or more in 5.0% of the patients. After 6months, there was cystitis found in less than grade 3 in 10.0% of the patients and more than grade 3 in 3.3% of the patients. Conclusion: In locally advanced squamous cell carcinoma of the uterine cervix, the addition of concurrent injection of cisplatin to ICRT significantly improves locoregional response but increases the incidence of hematological and mucosal toxicity, which is manageable.
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Phenotypic detection of metallo-beta-lactamase production in clinical isolates of Escherichia coli and Klebsiella pneumoniae in a tertiary care hospital Highly accessed article p. 149
Smita S Kulkarni, Manjushree V Mulay
DOI:10.4103/mgmj.mgmj_12_22  
Introduction: Carbapenem resistance due to metallo-beta-lactamase (MBL)-producing bacteria is an emerging threat worldwide. This study aimed to detect the MBL production in clinical isolates of E. coli and Klebsiella pneumoniae species in our hospital setting and to evaluate the efficiency of two phenotypic methods for the detection of MBL production. Materials and Methods: The present study was carried out in the Department of Microbiology, MGM Medical College and Hospital, Aurangabad, Maharashtra, for a period of 2 years from April 2018 to March 2020. From a total of 12,324 various clinical specimens, 393 isolates of E. coli and Klebsiella pneumoniae species were tested for MBL production. MBL was detected by two different phenotypic methods, i.e., combined disc test and E-test. Results: Out of 393 isolates, 130 (33.07%) isolates were resistant to imipenem on screening of which 71 (18.06%) were Klebsiella pneumoniae and 59 (15.01%) were E. coli. About 43.66% Klebsiella pneumoniae isolates and 40.67% E. coli isolates were MBL-positive by the combined disc test. Using the E-test, MBL production was found to be 46.47% and 45.76% in Klebsiella pneumoniae and E. coli, respectively. Conclusion: Routine screening of MBL-producing organisms should be performed in diagnostic laboratories to control the spread of resistance and for the proper management of antibiotic therapy. E-test is better than the combined disc test for the detection of MBL-producing gram-negative bacilli.
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Knowledge, attitude, and practice of ‘over-the-counter’ medications among medical and non-medical professionals during COVID-19 pandemic p. 154
Asawari Raut, Biji Elza Varghese, Digamber Rajendra Singh, Shirin Mariyam Reji
DOI:10.4103/mgmj.mgmj_10_22  
Background: India is one of the emerging markets for over-the-counter (OTC) drugs and offers significant growth potential for the industry. There has been a huge rise in the use of OTC drugs since the beginning of the pandemic for which some major reasons are lack of time, non-availability of prescribers, and hospital exposure during a pandemic. Aim: To assess knowledge, attitude, and practice (KAP) of ‘over-the-counter’ medications among medical and non-medical professionals during the COVID-19 pandemic. Settings and Design: The study was conducted at Bharati Hospital and Research Center, Pune, Maharashtra, India. Materials and Methods: A descriptive observational study was conducted. Statistical Analysis Used: Descriptive (mean, percentage, and standard deviation) and inferential (chi-square test) statistics were used. Statistical analysis was done using the Statistical Package for the Social Sciences(SPSS) software version 10.0. Results: Out of 310 samples majority showed poor knowledge (50.65%), high practice (56.13%), and negative attitude (70%) towards the use of OTC drugs. There is a significant association found between age (p-value 0) and health care status (p-value 0) with the level of knowledge. Age group (p-value 0.046) and employee status (p-value 0.00033) showed a significant association with the practice of OTC drugs. Healthcare status showed a significant association (p-value 0.0007) towards attitude toward the use of OTC drugs. Conclusion: Participants reported overall poor knowledge with a negative attitude and adopted the high practice use of OTC drugs during the COVID-19 pandemic. Increased awareness about self-medication is important to avoid complications associated with the high practice of OTC medications.
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Emerging ethical dilemmas in the use of intelligent computer programs in decision-making in health care: an exploratory study p. 160
Grrishma Balakrishnan, Vina Vaswani, Padmini Thalanjeri
DOI:10.4103/mgmj.mgmj_34_22  
Background: Medical professionals are under tremendous stress due to various occupational stressors, and Artificial Intelligence (AI) geared toward patient care might look like a preferable solution in alleviating some amount of stress. Hence, the study assessed the level of awareness and perception of the ethical dilemmas of health professionals on intelligent computer programs in independent healthcare decision-making. Materials and Methods: The present study is a cross-sectional, non-interventional, and questionnaire-based descriptive study. This study was done in a Deemed to be University Hospital, Karnataka, India. Of the total 96 participants, 30 were medical participants, 36 were dentists, and 30 were nurses. A pretested and validated questionnaire was used to collect the participants’ responses. Results: Medical and nursing participants opined that intelligent computer programs can take both major and minor independent decisions in inpatient care when the physician is unavailable. The majority of the participants felt that in the decisions made by the intelligent computer programs, patients’ rights and wishes might not be respected, compromising autonomy. The majority agreed that computer-assisted information extraction helps in better treatment of patients causing beneficence. Medical and dental participants thought that intelligent computer programs cannot communicate well with patients, do not have a conscience, and can be hacked causing maleficence. Participants opined that the use of intelligent computer programs could serve justice in the form of equity and equality in health care. Conclusion: Breach of patient autonomy due to data mining, loss of confidentiality, and disrespect for patients’ rights and wishes are major concerns when AI takes independent decisions in health care. One of the most desirable outcomes of AI in health care could be an increase in equity and equality of the reach in health care to the rural population.
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Correlation of biomarkers and radiological findings among COVID-19 patients: a retrospective study p. 168
Subbarao Anil Kumar, Karthik Shyam, Shruthi Kulkarni
DOI:10.4103/mgmj.mgmj_3_22  
Introduction: The severity of COVID-19 is classified based on clinical, laboratory, and radiology characteristics. Although chest X-ray (CXR) is not sensitive in early stage disease, it can be useful in assessing the rapid progression of lung abnormalities in COVID-19. While CXR findings correlate with the severity of the disease, computed tomography (CT) scans of the chest are widely and repeatedly done. As it exposes the patient to a large dose of radiation and risks the spread of infection to other patients, it is worthwhile to explore the utility of CXR to overcome the above problem, especially in resource-poor settings. Materials and Methods: Inpatients with reverse transcriptase–polymerase chain reaction (RT-PCR)-positive COVID-19 irrespective of severity, admitted in the COVID wards from June to September 2020, were included in a retrospective study. CXR done at admission was scored for radiological severity of COVID-19 by an independent radiologist, unaware of the clinical/laboratory parameters of patients. It was then co-related with clinical severity and standard biomarkers at admission. Results: We studied 400 patients, the mean age (SD) was 53.69 (15.43) years, 268 (67%) were males, the majority of them were symptomatic (95%), 192 (48%) had severe disease, and 238 (59.5%) patients had co-morbidities. Receiver-operating curve (ROC) for CXR severity score showed a threshold of 3.5 to predict severe COVID, which had a positive predictive value of 71% and a negative predictive value of 73%. Using Pearson’s correlation coefficient, CXR severity scores significantly correlated with the clinical severity and standard biomarkers. Conclusion: With the overwhelming number of COVID-19 patients burdening the healthcare system, monitoring of the severity of the disease can be achieved with regular clinical assessment and laboratory parameters with limited radiation exposure, avoiding repeated CT scans, especially in resource-poor settings.
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Students’ response to implementation of ‘OSPE’ as a tool for assessment of practical skills of undergraduates in the subject of anatomy p. 173
Smita Shinde, Gautam Ajit Shroff, Suvarna Gulanikar, Savita Kadam
DOI:10.4103/mgmj.mgmj_15_22  
Introduction: For evaluating the practical knowledge of the students, objective structured practical examination (OSPE) has been used as a tool several times. The assessment of the student’s potential in different ways is a part of medical education. The practical examination is a typical method of assessment of practical and clinical skills but it lacks an assessment of the psychomotor and communication skills of the student. OSPE formats address these lacunae of the current system. However, it is necessary to assess the OSPE from a student’s perspective. The current study is designed to obtain the student’s opinion regarding OSPE as a tool of assessment in practical examinations. Aims and Objectives: To determine the opinion of students about OSPE as a tool among1st-year medical undergraduates to assess the teaching-learning process in anatomy. Materials and Methods: 150 first-year undergraduates of competency-based medical education (CBME) batch of 2019–20 from the Department of Anatomy of MGM Medical College, Aurangabad, India were chosen for assessing practical skills. A structured questionnaire was designed and distributed among them to collect the required data to assess students’ evaluation of the OSPE. Results and Observations: A total of 150 questionnaires were filled by students with a 90% response rate. The majority of the students favored the inclusion of OSPEas as an assessment tool in the final examinations. Conclusion: The study reveals that the majority of the students (68%) have found OSPE as an acceptable tool. The OSPE is reliable for formative as well as a summative assessment for undergraduate medical students.
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Community mapping of COVID-19 cases admitted from April to June 2020 at a tertiary health care hospital in Raigad district in Maharashtra, India p. 177
Saili Jadhav, Prasad Waingankar, Mansee Thakur
DOI:10.4103/mgmj.mgmj_22_22  
Introduction: At end of 2019, a novel coronavirus caused severe acute respiratory syndrome, which emerged in Wuhan, Hubei province of China. Health professionals have always used conventional mapping (in recent times geographic information systems [GIS] mapping) as a useful tool for better tracking which further facilitated better management of deadly contagions such as SARS-CoV 2. This study aimed to map geographically the positive patients admitted in a dedicated COVID-19 hospital which is a tertiary care hospital from April to June 2020 to gain insight into the local viral transmission and pattern of geographical spread because of ongoing cluster transmission. Objectives: The aims of this study were (1) to locate geographically the COVID-19 cases admitted from April to June 2020 at a tertiary health-care facility, (2) to study trends and patterns of geographical spread, and (3) to identify geographical clustering of cases, if any. Materials and Methods: This was an observational, cross-sectional, secondary data-based study. The study was conducted at MGM Medical College Hospital, Kamothe. The data were collected from existing surveillance and lab data records. The data were analyzed in Excel and Epi info. Specialized GIS software was used for mapping to Taluka level based on patients’ addresses using standard “.shp” files for the local area. Results: There were a total of 968 cases. The majority of which were from Raigad district (839, 87%). The Panvel taluka in Raigad District having Panvel as a major city and the thickly populated urban area has shown clustering of cases extending to neighboring Uran taluka. Conclusion: For better preparedness, we need to keep tracking new outbreaks through GIS and promote further advances in mapping technologies.
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A study on knowledge, attitude, and practices about COVID-19 among community health officer trainees under health wellness center program study centers in Maharashtra, India p. 182
Pallavi Bhimrao Kunde, Shobha Bansi Salve, Rajesh Keshavrao Dase
DOI:10.4103/mgmj.mgmj_25_22  
Background: Coronavirus disease-2019 (COVID-19) is a rapidly spreading pandemic. Under the Ayushman Bharat Scheme of Govt. of India, community health officer (CHO) trainees undergo 6 months of training to provide comprehensive primary health care to the patients attending health wellness centers. Aims and Objectives: This study was conducted to assess the knowledge, attitude, and practices (KAPs) about COVID-19 among CHO trainees in Maharashtra. The relation between sociodemographic factors of CHO trainees and their KAPs was also studied. Materials and Methods: An online study was conducted during September 15, 2020 to October 15, 2020 among CHO trainees of the March 2020 batch undergoing training under health wellness program study centers in Maharashtra using a prevalidated questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25.0. Results: One hundred and sixty CHO trainees participated in this study. The majority of respondents (98 [61.3%]) were females with a mean age of 27.86 years (SD 4.862) and (range 20–43 years). Seventy-five (46.8%) respondents were ayurvedic doctors, whereas 85 (53.2%) were nursing graduates. Overall, 159 (98.76%) had sufficient knowledge, 126 (78.26%) had a positive attitude, and 65 (40.37%) had fair practices toward COVID-19. Age >30 years was associated with good knowledge. CHO trainees with age ≥ 30 years and using social media to access information on COVID-19 were having a good attitude. CHO trainees with age ≥ 30 years, working in the civil hospital and those with Bachelor of Ayurveda, Medicine, and Surgery (BAMS) degrees were significantly (P < 0.05) more likely to have fair practices. Conclusion: Studies involving CHO training centers all over India should be conducted.
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Self-medication practice and health-seeking behavior among medical students during COVID 19 pandemic: a cross-sectional study p. 189
Swarnkanta Likhar, Konika Jain, Lokendra Singh Kot
DOI:10.4103/mgmj.mgmj_107_21  
Introduction: Self-medication practice (SMP), is the one element of self-care, the use of medication without the prescription of medical professionals for the treatment of self-recognized illnesses. (E.g., resubmitting old prescriptions, sharing medication with relatives/family members, or using leftover medications) This study aims to determine the prevalence of self-medication practice and health-seeking behavior among medical students during the Covid 19 pandemic. Materials and Methods: This was a cross-sectional study on self-medication practice. A total of 510 MBBS students at Government Medical College, Ratlam were enrolled in the study taking care of inclusion criteria. Data was collected on a pre-designed semi-structured questionnaire through Google forms and was analyzed using Epi info (CDC version 6). Result: Out of 510 MBBS students, 394 students responded to fill the form with an overall response rate of 77%. Self-medication practice in the preceding 6 months amongst MBBS students was 291 (73.85%). There is a significant association between self-medication practice with age, gender, and 1st, 2nd and 3rd year of MBBS. Health-seeking behavior among students was found to be 26.14%. Conclusion: Self-medication practice is widely prevalent amongst MBBS students, especially during the Covid pandemic. Approx. 74% of MBBS Students practiced self-medication in the preceding 6 months.
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Awareness and practice of breast self-examination (BSE) with its socio-demographic associates: a cross-sectional survey in the capital of Rajasthan, India p. 196
Pragya Kumawat, Ajay Gupta, Kusum L Gaur, Sadhana Meena, Gajendra S Sisodia, Ishrat Jahan
DOI:10.4103/mgmj.mgmj_13_22  
Introduction: Breast cancer is the most common cancer of women worldwide. Early diagnosis of it has a very important role in its management. Breast self-examination (BSE) is a key to the early diagnosis of breast cancer. Materials and Methods: A community-based cross-sectional study was conducted on 300 females of Jaipur city. This study was conducted by a house-to-house survey through a systematic random sampling technique in the field practice area of the Urban Health Training Centre (UHTC) of SMS medical college, Jaipur (Rajasthan), India. A predesigned semi-structured questionnaire containing predesigned questions regarding knowledge and practice of BSE was used to collect data. A Chi-square test was used to find out associations. Results: Only 18% of females were aware of BSE and 5.7% of the females were practicing BSE. Health professionals (31.03%) were the main source of knowledge. Only 50% of females who have heard the name of BSE, knew that it is performed by self. Awareness and practice of BSE both were found to be associated with religion, education, socioeconomic status, and occupation and there was no association with age and marital status. Females with higher education and socioeconomic status were more aware of BSE. The most common (94.69%) reason for not practicing BSE was the lack of awareness of steps followed by ‘find it unnecessary’. Conclusion: As knowledge and practice of BSE were observed very poor and considering the important role that can be played by BSE in the early diagnosis and management of breast cancer, there is an urgent need to implement and reinforce BSE in the existing cancer awareness and screening programs. IEC activities regarding BSE also motivated proper knowledge of BSE.
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REVIEW ARTICLES Top

Exploring clues for wide variations in COVID-19 fatality rates among countries p. 202
Prasanta Kumar Ghosh
DOI:10.4103/mgmj.mgmj_55_22  
COVID-19 flu has been the worst pandemic on earth in more than a century and has thus far claimed more than six million lives worldwide. As of 19th March 2022, there were 57 major countries where one million or more COVID-19cases were registered, and the deaths reported therein constituted 92.3% of the total deaths worldwide. The high mortality rate is associated with comorbid conditions of the infected. Obesity, diabetes, cardiovascular diseases, high blood pressure, chronic obstructive pulmonary diseases, tuberculosis, and a higher percentage of the aged population (more than 65y) were identified as major morbidity conditions among others. Mycobacterium sensitized healthy people were found to resist the disease more efficiently. Prior vaccination with human influenza virus vaccines had considerable protective effects against catching or manifesting severity in COVID-19 flu. Timely vaccination with an approved vaccine against SARS-CoV-2 was considered immensely protective from the disease. All countries should therefore adopt policy measures that ensure adequate vaccination among their population.
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Effectiveness of transcranial magnetic stimulation in stroke patients: a mini-review p. 215
Priyanka Sindwani, Priya Chauhan
DOI:10.4103/mgmj.mgmj_60_22  
Transcranial magnetic stimulation (TMS) is normally used for the effects of stroke on corticomotor satisfaction, intracortical function, and interhemispheric interactions. The interhemispheric inhibition model states that the detection of motor function after a stroke is linked to a re-evaluation of asymmetric interhemispheric inhibition and corticomotor excitability. This model creates a reason to use neuromodulation techniques to reduce the excitement of the unaffected motor cortex and to facilitate the excitement of the affected motor cortex. However, the proof base for using neuromodulation strategies to decorate motor recovery after a stroke is not blanketed. Among stroke patients, TMS has become increasingly popular, as variations in neuronal sensitivity generated via modifications in the ionic balance of activated neurons are accountable for the quick-time period consequences of TMS. But, to be effective and accurate in treating sufferers, we gathered information from several sources, including articles with the terms TMS and stroke rehabilitation in the title. The previous research has mostly relied on randomized controlled trials; hence, a review of age studies with carefully determined inclusion criteria is required. The most important findings from this study’s implications and relevance are that TMS is somewhat beneficial, but there are still considerably more advances to be made for accurate and effective results.
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Noninvasive screening of osteoporosis using bio-impedance and quantitative ultrasound p. 220
Jyoti Vivek Jethe, Deepak Patkar, Ghanshyam D Jindal
DOI:10.4103/mgmj.mgmj_75_22  
Bone mineral loss is a serious health issue all over the globe resulting in osteoporosis, without showing any pre-indication of its occurrence. Dual Energy X-ray Absorptiometry test is a widely accepted method for its diagnosis which gives areal information about the bone mineral. Other methods like Quantitative Computed Tomography (QCT) and Peripheral QCT give volumetric information. Application of these methods for mass screening is not recommended due to the use of ionizing radiations. Few non-ionizing methods, namely Bioelectric Impedance Analysis and Quantitative Ultrasound, have evolved in the past few decades. Bioelectric Impedance Analysis, a non-invasive and low-cost tool, has been immensely recognized for its promising use in estimating body composition and body fluids. Similarly, Quantitative Ultrasound is another non-invasive technique for determining bone density at fixed locations, making noninvasive assessment much faster, easier to use, and portable. A multi-parametric approach combining these two modalities has yielded higher efficiency for the detection of bone mineral loss. These developments are briefly reviewed in this paper.
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CASE REPORTS Top

Disseminated tuberculosis presenting as cardiac tamponade—Uncommon presentation in common disease p. 229
Majed A B Momin, Pawan Poddar, Amit K Sarda, Dharmendra K Borad
DOI:10.4103/mgmj.mgmj_62_21  
Tuberculosis is the most common infection in India, and its incidence accounts for approximately one-fifth of the global burden. Cardiac tamponade resulting from the liver abscess with subdiaphragmatic rupture communicating with pericardial cavity presenting as disseminated tuberculosis is uncommon. Here, we reported a case of a 63-year-old man who presented with the shortness of breath for 3 days with orthopnea. Imaging studies reveal pericardial effusion, left liver lobe loculated lesion, and enlarged right supraclavicular lymph node. Further image-guided pericardiocentesis, left liver lobe aspiration cytology, and right supraclavicular lymph node cytology reveal granulomatous inflammation with positive acid-fast bacillus in the liver aspirate. The patient was managed in the emergency room symptomatically initially and was then successfully treated with antituberculous treatment.
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Malakoplakia of the prostate p. 234
Nisha T Gopalakrishnan, Prema Saldanha, Bency Shamsudeen
DOI:10.4103/mgmj.mgmj_29_22  
Prostatic malakoplakia is a rare chronic inflammatory disease with only a few cases reported in the literature. It is believed to be caused by an impaired histiocytic response against bacteria. This is a case report of a 65-year-old man with a history of diabetes mellitus presenting with complaints of generalized weakness and fever of 4-day duration. Laboratory investigations showed pyuria, and urine culture showed Escherichia coli. An abdominal Computerised Tomography (CT) scan revealed left-sided pyelonephritis and a prostatic abscess. Double-J stenting with Trans-Rectal Ultrasound Scan (TRUS) biopsy was done. The biopsy showed features of malakoplakia of the prostate without any associated malignancy.
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Unusual presentation of membranous nephropathy p. 238
Ankit Data, Kshitija G Gadekar, Vajed R Mogal, Shrutilaya Ayyagari, Sudhir Gajanan Kulkarni
DOI:10.4103/mgmj.mgmj_60_21  
Stroke is one of the most severe complications of nephrotic syndrome (NS) which causes severe mortality and morbidity and patient initially presenting with stroke is rare. Here, we describe a case in which an 18-year-old female presented with ischemic stroke as an initial complication of membranous nephropathy (MN). Renal biopsy showed features of MN. This case illustrates that it is important to diagnose MN and anticoagulated this high-risk group of patients before they develop severe complications. There are only a few cases in the literature where the initial presentation of MN is ischemic stroke and it occurs in a young female patient with no risk factors apart from NS.
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Laparoscopic repair of post hysterectomy ureterovaginal fistula p. 242
Siddharth Shah, Nidhi Thumar, Sushil Kumar
DOI:10.4103/mgmj.mgmj_38_22  
The fistulas, following gynecologic, surgeries are not uncommon. Hysterectomy is one of the most common causes of lower urinary tract fistula in pelvic surgery. Higher incidences are associated with laparoscopic hysterectomy as compared to vaginal or abdominal hysterectomy. Early identification and management of ureterovaginal fistula (UVF) are of utmost importance. The laparoscopic approach in the management of UVF is preferred over open surgery as it reduces pain, hospital stay, and morbidity. However, the laparoscopic approach needs higher surgical dexterity, sound knowledge of pelvic anatomy, and has a higher learning curve. One such approach is discussed here.
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Posterior reversible encephalopathy syndrome in pregnancy: A case series of 5 cases p. 246
Vaibhavi Birle, Pradnya Dongargaonkar, Sunil Sharma, Aditi Sandip Gaiwal
DOI:10.4103/mgmj.mgmj_30_22  
Posterior reversible encephalopathy syndrome (PRES) is a rare clinic-radiological syndrome associated with acute changes in blood pressure during pregnancy. It is characterized symptomatically by headache, seizures, altered mental status, and visual blurring. Radiological changes are white matter vasogenic edema affecting the occipital and parietal lobes of the brain. It is being increasingly recognized due to increased institutional deliveries and advances in imaging particularly magnetic resonance imaging (MRI). Despite the increasing detection, the prediction of PRES and patient factors affecting susceptibility is still not clear. Hence, we conducted a retrospective study to analyze the factors associated with PRES at our tertiary care center.
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A case of subclinical hypothyroidism with cerebellar ataxia p. 250
Shwet Sabnis, Tushar K Biswas
DOI:10.4103/mgmj.mgmj_82_21  
Hypothyroidism is a common condition, the symptoms and signs of which vary with the duration and magnitude of thyroid hormone deficiency. Hypothyroidism can have rare neurologic problems such as reversible cerebellar ataxia. Subclinical hypothyroidism refers to biochemical evidence of thyroid hormone deficiency in patients who have few or no apparent clinical features of hypothyroidism. Here, we present a case of a 70-year-old woman with complaints of giddiness and unsteadiness of 6 months’ duration. Subsequent evaluation revealed titubation, broad-based reeling gait, and dysarthria. A MRI of the brain showed diffuse moderate cerebral atrophy with periventricular ischemic white matter changes and normal cerebellum. Further investigations revealed evidence of subclinical hypothyroidism. The patient was started on oral thyroxine supplements with a relief of symptoms following 3 weeks after the initiation of treatment and a complete recovery from symptoms after about 3 months of the initiation of treatment. The association of cerebellar involvement at the stage of subclinical hypothyroidism is a rare finding, making the case academically interesting.
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LETTERS TO EDITOR Top

How effective is daytime oral exogenous melatonin supplementation in improving sleep quality and duration? p. 254
Chidiebere Emmanuel Okechukwu, Chidubem Ekpereamaka Okechukwu
DOI:10.4103/mgmj.mgmj_7_22  
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2020–21: double-edged with COVID -19 pandemic & domestic violence p. 256
Ponnaganti Sai Venkata Kalyani, Sagina Krishnam Raju, Lakshmi Venkata Simhachalam Kutikuppala
DOI:10.4103/mgmj.mgmj_74_21  
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Pyrazinamide induced morbilliform rash: cutaneous complications in anti-tubercular therapy p. 258
Shatavisa Mukherjee
DOI:10.4103/mgmj.mgmj_102_21  
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Bodyright campaign: Minimizing the incidence of online violence against women p. 260
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mgmj.mgmj_104_21  
Gender-based violence refers to all forms of detrimental actions to target a single person or a group of them depending on their gender. This predominantly includes violence directed against women and includes all forms of violence (in the real world to online violence). We must understand and accept that even though these incidents are happening in the online world, the internet has become such an integral part of human life that the outcome of such violence is seen in the real life. The United Nations Population Fund has initiated a new online campaign in the name of Bodyrights, which is the new copyright mark to proclaim and demand security from the various incidents of digital violence. To conclude, gender-based violence has been reported universally, and the same things are on the rise even on the online platform, wherein women and girls are being targeted and their dignity and reputation are being tarnished. This calls for the need to raise to the occasion and the policy-makers and the technology companies should offer complete support to not only punish the offenders but even reduce the incidence of such events in the present and the future.
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