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   Table of Contents - Current issue
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July-September 2022
Volume 9 | Issue 3
Page Nos. 263-444

Online since Thursday, September 29, 2022

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EDITORIAL  

Management of postpartum hemorrhage – Current strategies p. 263
Sushil Kumar, Aditi Sandip Gaiwal
DOI:10.4103/mgmj.mgmj_149_22  
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ORIGINAL ARTICLES Top

Physical, emotional, and social well-being and toxicity assessment in post-mastectomy female breast carcinoma patients undergoing adjuvant treatment p. 268
Swapan K Mallick, Gufran K Nahid, Asit R Deb
DOI:10.4103/mgmj.mgmj_48_22  
Objective: Breast carcinoma is one of the most common cancers in India. Breast cancer is usually associated with serious side effects due to the long-term treatment procedure. This study investigates how to improve the overall quality of life (QoL) of patients in physical, psychological, and social aspects. Materials and Methods: Records of patients attending the Radiotherapy Outpatient Department (OPD) from May 2019 to June 2021 were analyzed retrospectively. Records of several patients available in the department were reviewed by the census method, which is based on pre-decided inclusion and exclusion criteria. Results: Out of 105 patients included in the study, 38.1% (N=40) of the patients were graduates, and 30.5% (N=32) of the patients were illiterate; 54.3% (N=57) of the patients belong to rural areas. Only 24.8% (N=26) of the patients were employed and the remaining 75.2% (N=79) of the patients were unemployed. However, most of the patients (41.0%) developed grade 1 acute skin toxicity, among which a maximum number of patients (N=47) developed grade1 late skin toxicity. After radiotherapy among all included patients, almost 13.0% of the patients developed arm edema. According to the Hospital Anxiety and Depression Scale score, the maximum abnormal scores for depression were 60.0% (N=63) and for anxiety 59.0% (N= 62). Conclusion: This study emphasizes that older women and those from lower socio-economic strata tolerated chemotherapy and radiotherapy better. We can also conclude that improved QoL has been a major concern for breast cancer patients undergoing long-term treatment. In a post-treatment setting, serial evaluation of the QoL not only improves the treatment outcome but can also be a prognostic factor.
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Principal component analysis of categorized parameters in periprocedural myocardial injury following percutaneous coronary intervention Highly accessed article p. 275
Malay Acharyya, Tanushree Mondal
DOI:10.4103/mgmj.mgmj_57_22  
Objective: The elevation of troponin-T (Trop-T) or creatinine kinase myocardial isoform (CKMB) is very common during the percutaneous coronary intervention (PCI). A study was attempted to determine the correlation between elevated Trop-T or CKMB and the parameters of PCI by using multivariate analysis, especially principal component analysis (PCA). Materials and Methods: A prospective observational study was carried out among 100 patients who underwent PCI for stable coronary artery disease in which 31 and 37 patients were found to have elevated Trop-T and CKMB (>3 times) following PCI. The correlation was studied between Trop-T or CKMB (dependent variable) and different parameters, viz., total stent length (mm), fluoroscopy time (min), lesion strength, left ventricular (LV) function, procedural complications, type of lesions, vessels treated with drug eluting stent (DES), and major adverse cardiac events (MACE) as independent variables. Results: For Trop-T, the principal component (PC)-1 and PC-2 obtained 63.49% and 30.88% of the original variation. For PC-1 and PC-2, maximum positive loading was recorded for stent length followed by fluoroscopy time and for LV but negative loading for the type of lesion and type of stent (DES vs bare metal stent [BMS]). For CKMB, the PC-1 and PC-2 obtained 61.22% and 32.08% of the original variation. For PC-1 and PC-2, maximum positive loading was recorded for stent length and fluoroscopy time followed by vessel treated but negative loading for the type of stent and MACE, and maximum positive loading recorded for LV function but negative loading for the type of lesion. Conclusion: This study indicates which factors are most important in preventing periprocedural myocardial injury during PCI and may be a suitable tool to prevent myocardial injury and for subsequent less MACE and better patient outcomes.
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Surveillance of venomous arthropods on a Nigerian Public University campus: An ecological study p. 281
Vivian Onyinyechukwu Ogbusu, Angus Ejidikeme Onyido, Chidiebere Emmanuel Okechukwu, Izunna Somadina Okwelogu
DOI:10.4103/mgmj.mgmj_67_22  
Background: Venomous arthropods are arthropod species that use toxins for defense and offense. The objective of this study was to assess the biodiversity and abundance of venomous arthropods on the premises of Nnamdi Azikiwe University (NAU), Awka, Nigeria. Materials and Methods: Pitfall traps, sticky, and bait traps, beating and knockdown, and active search and handpicking with forceps were the methods used to collect various arthropods on the university campus. The data collected during this study were analyzed using the statistical package for social sciences version 23.0. Results: A total of 1,070 venomous arthropods were collected from the study areas, and they belong to four classes, six orders, fourteen families, and twenty-two species of the phylum Arthropoda. Conclusion: This study demonstrates that venomous arthropods are widespread on the NAU, Awka campus. Regular fumigation of the university premises is important in preventing human injuries, and infectious diseases carried by some arthropods.
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Histopathological study of salivary gland tumors: a tertiary care hospital-based study p. 291
Pankaj R Pande, Amitkumar B Pandav, Vijay R Bhosale
DOI:10.4103/mgmj.mgmj_36_22  
Introduction: Salivary gland tumors (SGTs) are relatively uncommon and show a wide variety of morphological heterogeneities. The incidence of SGTs is said to be affected by geographical and racial factors. Histopathological diagnosis plays a major role in the diagnosis of these neoplasms. Objectives: This study investigated the incidence of SGTs and histopathological features of various SGTs, aimed at knowing the epidemiological pattern of these tumors and comparing the results of our study with other studies of SGTs in the literature. Materials and Methods: A retrospective study was conducted on SGTs at the Pathology Department of the Government Medical College and Hospital for a period of 5 years. Clinical and demographic data were documented and analyzed concerning histopathologic type. Results: A total of 86 SGTs were identified, 65.12% of which were classified as benign and 34.88% as malignant. Most tumors occurred in the parotid gland (59.14%). Pleomorphic adenoma (PA) was the most common tumor (56.98%), followed by mucoepidermoid carcinoma (MEC) (17.44%). The tumors occurred more often in men (51.16%) than in women (48.84%). Conclusion: SGTs exhibit broad morphological heterogeneity and these tumors are rare. The parotid gland is the most common location, and PA is the most frequent benign tumor. MEC followed by adenoid cystic carcinoma is the most common malignancy of the salivary gland.
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Imaging and clinical perspectives of rhino-orbito-cerebral mucormycosis: An epidemic born out of a pandemic p. 296
Syed M Danish Qaseem, Mohd Monis, Aiman Ibbrahim, Mohd Khalid
DOI:10.4103/mgmj.mgmj_89_22  
Purpose: To study the imaging and clinical perspectives of a recent epidemic of rhinocerebral mucormycosis during the COVID-19 (coronavirus disease) pandemic in India. Materials and Methods: This retrospective study included clinical and imaging data of 24 diagnosed cases of acute rhinocerebral mucormycosis who were presented to our hospital in May 2021. The clinical profile and imaging data of the patients were documented. Results: 18 patients (75.0%) had moderate to severe COVID-19 illness with a history of oral or intravenous corticosteroid intake. 19 patients (79.2%) had presented with hyperglycemia at the time of admission. Nasal discharges with or without black crusts and facial swelling (79.2%) were the most commonly reported complaints, followed by headaches or facial pain (62.5%). All cases demonstrated the involvement of one or more paranasal sinuses in imaging, with predominantly unilateral involvement. Extra sinusoidal involvement was commonly seen, with abnormalities seen in retromaxillary and masticator space, orbit, face, oral cavity, pterygopalatine fossa, and deep spaces of the neck, cavernous sinus, and brain. Conclusion: An upsurge of mucormycosis cases during the COVID-19 pandemic appears to be closely related to uncontrolled hyperglycemia and corticosteroid therapy. Computed tomography (CT) and magnetic resonance (MR) imaging are invaluable in establishing an early diagnosis, defining the extent of disease, and helping in immediate surgical planning.
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Effect of stretching exercises on menstrual pain among adolescent girls p. 303
Vaishali Chandrakant Talekar, Maharaj Singh, Kalpana Kamble, Dhiraj Kumar Mane
DOI:10.4103/mgmj.mgmj_85_22  
Background: Pain is an unpleasant, intense feeling. During menstruation, contraction of the uterus to expel the built-up lining. Prostaglandin hormone is responsible for the muscle contraction in the uterus, which causes press against the blood vessels around it. It leads to a cut-off oxygen supply to muscle tissue, which triggers pain. One of the treatments for primary dysmenorrhoea is regular exercise and relaxation techniques. Stretching exercises help to relieve pain by reducing stress, improving flexibility, and strengthening the muscle. This study aims to find out the effect of stretching exercises on menstrual pain among adolescent girls. Materials and Methods: A cross-sectional evaluative study was conducted among the adolescent girls of Selected schools in Navi Mumbai, India from October 2021 to February 2022 to analyze the relationship between stretching exercises and menstrual pain among adolescent girls. A numerical pain scale and a modified women’s health questionnaire were used to collect data from 100 adolescent girls. The non-probability purposive sampling technique was used to select adolescent girls. Statistical Analysis: SPSS 24.0, software was used to tabulate and analyze the data. Results: This study result shows that a maximum of girls from age of 15–17 years (48%). A total of 82% of girls experienced menstrual pain. After doing stretching exercises, girls reduced their total pretest mean score from 2.65 to 1.99 post-test mean score. Posttest menstrual symptoms were reduced than the pretest menstrual symptoms after 8 weeks of intervention, so it was proven that stretching exercises helped in reducing menstrual pain and coping with problems.(‘p-value was <0.0001. Conclusion: Menstrual pain was a common problem among adolescent girls in schools of Navi Mumbai, Maharashtra, India. Dysmenorrhea adversely affects school attendance in adolescents. Regular daily exercises were can help to reduce menstrual pain among adolescent girls.
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Assessment of glycated hemoglobin levels in non-diabetic subjects with recently diagnosed hypo and hyperthyroidism p. 309
Sujesh K Narayanan, Renjith G Pillai
DOI:10.4103/mgmj.mgmj_77_22  
Background: Thyroid disorders are highly prevalent in the general population and generally manifest as hypothyroidism or hyperthyroidism. Glycated hemoglobin (HbA1c) is commonly used for the assessment of the long-term glycemic status of diabetic patients. But the HbA1c concentration not only depends on prime glycemia but some other factors. Aims and Objectives: The objective of this study was to measure glycated hemoglobin and thyroid hormone levels and aimed to determine the effects of hypo and hyperthyroidism on glycated hemoglobin in non-diabetic patients. Materials and Methods: This case-control study was conducted on 70 euglycemic individuals each newly diagnosed with hypo and hyperthyroidism. Seventy age and gender-matched controls were recruited. Baseline HbA1c was estimated by high-performance liquid chromatography (HPLC) and thyroid status was measured by chemiluminescent immunoassay (CLIA) method in all cases and controls and then compared. Results: HbA1c values were found to be significantly higher in the hypothyroid group (P < 0.001), whereby its values in hyperthyroid subjects showed no significant difference from controls (P = 0.17). A positive correlation (r=0.67) exists between the levels of thyroid-stimulating hormone (TSH) and HbA1c in hypothyroid patients, but no significant correlation (r= -0.07) was observed for hyperthyroid subjects. Conclusion: HbA1c may not be a reliable indicator of glycemic status in patients with hypothyroidism, and so HbA1c results should be interpreted with caution in such patients.
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Awareness and perception of public/civil servants toward the National Health Insurance Scheme in Minna, Niger State, Nigeria Highly accessed article p. 315
Ezekiel James, Olaiya P Abiodun, Olaniyi F Sanni
DOI:10.4103/mgmj.mgmj_69_22  
Background: Nigeria’s healthcare system has been characterized by a decline in healthcare service providers due to the inability of governments to adequately fund healthcare services over the years. Thus, this study aims to assess the knowledge and perception among public/civil servants toward the National Health Insurance Scheme (NHIS) in Minna, Niger State, Nigeria. Materials and Methods: The study was conducted using mixed qualitative and quantitative research methods. The study employed a descriptive research design that is also comparative. Data were collected using questionnaires and presented and analyzed using IBM-SPSS version 25.0 for Windows with the help of tables and graphs. Results: Most respondents were aware of the National Health Insurance Scheme (NHIS), but there was an overall unimpressive perception of NHIS funding, cost, and coverage. Age, gender, marital status, education, and grade level were not considerably associated with knowledge of NHIS (P > 0.05), but those spending more than 5000.00 Nigerian Naira (NGN) monthly on medical bills were more aware of NHIS than those paying ≤2000 (P < 0.05). The perception of NHIS was not significantly associated with gender, marital status, grade level, education attainment, and monthly expenses on healthcare services (P > 0.05) but was significantly associated with age. Conclusion: The study concluded that there is a high awareness of NHIS among the study respondents, although not all had in-depth knowledge of the operations of the health insurance scheme. More efforts are required to increase awareness of NHIS and its benefits among public/civil servants in Minna, Niger State, Nigeria, to improve participation in the scheme.
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A prospective comparative study of concurrent chemoradiation in advanced carcinoma cervix patients with weekly cisplatin vs. weekly cisplatin and paclitaxel p. 330
Amit K Mukherjee, Linkon Biswas, Soumyo Bose, Shyam Sharma, Srikrishna Mandal
DOI:10.4103/mgmj.mgmj_46_22  
Background: Cisplatin-based concurrent chemoradiation is the standard treatment for carcinoma cervix. However, there is a need to explore alternative chemotherapeutic agents to further improve the treatment outcome. In this study, weekly paclitaxel and cisplatin-based chemoradiation was compared with weekly cisplatin-based chemoradiation in terms of disease control and toxicity profile. Materials and Methods: Sixty-four patients with FIGO stage IB2-IIIB squamous cell carcinoma of the uterine cervix were divided (by simple random sampling) into two groups: control arm patients who received radiotherapy (50 Gy in 25 fractions over 5 weeks) with concurrent weekly cisplatin (40 mg/m2) and study arm patients received same radiation dose with weekly cisplatin (30 mg/m2) and paclitaxel (40 mg/m2). After that, all patients received brachytherapy 21 Gy/three fractions, one fraction/week. All patients were followed up weekly during treatment, then 4–6 weeks after treatment completion, and thereafter monthly for at least 6 months. Results: The overall treatment response (complete+ partial response) was numerically higher in the cisplatin-containing control arm, but not significant (93% vs. 80%, P-value = 0.406). High-grade early rectal (60% vs. 25%, P-value = 0.014) and acute gastrointestinal toxicity (66% vs. 6%, P-value <0.001) were significantly higher in the cisplatin and paclitaxel-containing arm. Hematological, renal, late rectal, and bladder toxicities were also numerically higher in the study arm, but not statistically significant. Conclusion: There was no significant benefit of weekly paclitaxel and cisplatin as an alternative to weekly cisplatin-based chemoradiation in the treatment of carcinoma cervix.
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Odontogenic tumors: A histopathological overview p. 336
Sumedha P Shinde, Arvind J Vatkar
DOI:10.4103/mgmj.mgmj_39_22  
Introduction: Odontogenic tumors (OTs) are rare and account for around 1% of jaw lesions including tumor and tumor-like lesions. OTs are a diverse category of lesions, displaying different inductive interactions. Although some are hamartomas, others are benign and malignant neoplasms with varying degrees of aggressiveness. Materials and Methods: We plan to review the histopathological aspects of OTs because of their diverse properties. At a tertiary medical and dental institute in Pune, India, we studied 28 cases of OTs over 2 years, from 2013 to 2015. Results: The most common forms of OTs were ameloblastoma (42.86%) and odontogenic keratocyst (21.15%). The highest number of OTs was found in the 21–30-year-old age group, with an even gender distribution. Conclusion: Ameloblastoma is the most common OT, accounting for roughly one-quarter of all jaw tumors. The majority of OTs occurs in young people aged 20–40 years. Fortunately, malignant OTs are extremely rare.
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Efficacy of B-Lynch compression suture for control of intractable hemorrhage during cesarean section p. 345
Priya Manohar Bagade
DOI:10.4103/mgmj.mgmj_37_22  
Background: Primary postpartum hemorrhage (PPH) due to atonicity during lower segment cesarean section is commonly seen in obstetric practice. Usually, it responds to uterotonics but at times it may lead to life-threatening complications. B-Lynch brace suture is a fertility-preserving alternative surgical technique used in patients with primary atonic PPH not responding to uterotonics. This study was conducted to find out the efficacy of B-Lynch sutures in the surgical management of atonic PPH and prevention of obstetric hysterectomy in the same patients. Materials and Methods: The study included 34 patients with primary atonic PPH during cesarean section refractory to oxytocics and managed with B-Lynch brace sutures. It was a cross-sectional observational study conducted over 1 year at a tertiary hospital. The amount of blood loss, any additional surgical procedure required, and associated complications were studied in these patients. Results: Fertility could be preserved in 100% of the patients undergoing B-Lynch sutures for primary atonic PPH, following the failure of the medical line of management. No major complications including uterine wall necrosis or pyometra were observed in any of these patients. Conclusion: B-Lynch suture is a safe, effective, simple, life-saving, and fertility-preserving surgical technique in the treatment of primary PPH that requires lesser expertise. So it can easily be used before major interventions such as uterine devascularization or obstetric hysterectomy.
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Comparative study of epidural fentanyl with bupivacaine and epidural tramadol with bupivacaine for postoperative pain management in orthopedic lower limb surgeries p. 351
Yarramsetti V Rao, Hari K V Nadimpalli, Lakshmi V S Kutikuppala
DOI:10.4103/mgmj.mgmj_35_22  
Introduction: Pain is a complex subjective sensation that is difficult to quantify in a repeatable manner. Surgical pain is observed to be more intense post-surgery and then fades in the next 24 h. Epidural anesthesia/analgesia is the most widely used technique for lower limb surgeries because of its good sensory and motor block property, reduces stress response, and maintains sufficient spontaneous respiration and hemodynamic stability. Materials and Methods: The study looked at 100 individuals between the ages of 20 and 60 who underwent elective lower limb surgery and were classified as ASA I and II. The patients were split into two 50-person groups. The adverse effects of nausea, vomiting, respiratory depression, urine retention, and pruritus, as well as the quality and duration of postoperative analgesia, were investigated. The patient was monitored for 48 h after surgery. Results: A total of 100 patients were included in the study, where the least age of the patient was 19 years and the greatest age was 75 years. In group T, maximum patients belong to the age group of 26–35 years, whereas in group F maximum patients belong to the age group of 36–45years. In group T, 41 (82%) were males and 9 (18%) were females. In group F, 37 (74%) were males and 13 (26%) were females. Conclusion: Our findings show that epidural tramadol and epidural fentanyl are equally effective, except for fentanyl’s shorter duration of action. Fentanyl also has a moderate sedative effect, which is beneficial in the postoperative period.
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Open safety pin in the pediatric airway: our experiences at a tertiary care teaching hospital p. 356
Santosh K Swain, Jasashree Choudhury, Debasmita Dubey
DOI:10.4103/mgmj.mgmj_32_22  
Background: Aspiration of an open safety pin in the airway is an extremely rare and critical condition that needs immediate and safe removal of the foreign body (FB). An open safety pin in the airway of the pediatric patient requires urgent recognition. Imaging will confirm the exact site of the open safety pin in the airway. Rigid bronchoscopy with optical forceps or grasping forceps is an ideal tool for the removal of the open safety pin from the airway. Objective: This study aims to evaluate the clinical details, management, and outcome of pediatric patients with an inhaled open safety pin in the laryngotracheal airway. Materials and Methods: This is a retrospective descriptive study done between November 2016 and December 2021. There were six children with inhaled open safety pins in the laryngotracheal airway. The diagnosis was done through proper history taking, clinical examination, and the X-ray of the neck and chest of the children. All children underwent rigid bronchoscopy with optical forceps to remove the open safety pin. Results: Out of the six children, four were boys and two were girls. Out of the six cases, four were in the proximal part of the airway and two were seen in the distal airway. The most common clinical presentation was coughing. In this study, open safety pins of the pediatric airway were removed successfully under general anesthesia with the help of a rigid bronchoscope. Conclusion: Open safety pin is rarely found in the laryngotracheal airway. Open safety pin may cause a life-threatening complication. During the removal of the open safety pin, the surgeon should maintain maximum care to not injure the surrounding structures by the sharp end of the open safety pin.
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Study of prevalence and operative results of fracture shaft femur in adults p. 362
Poojan V Shah, Parag M Tank, Nimish B Patel, Keval S Italiya
DOI:10.4103/mgmj.mgmj_117_22  
Background: Being the principal weight bearing of the lower limb, fractures related to the femur pose a threat to humans and affect the overall quality of life. Conservative management is no longer preferred, and stable internal fixation is the modality of treatment these days. Aims and Objectives: The aim of this article is to study the operative outcomes of fixation of fracture shaft femur in terms of union, stability, functional outcomes, and complications. Materials and Methods: This study is a retrospective study of 35 patients with proximal, mid-shaft, and extra-articular distal shaft femur fractures admitted to Smt. SCL Municipal Hospital for 3 years from May 2019 to May 2022. Results: The results showed improvement in all the functional and radiological outcomes. More than 70% of the patients achieved greater than 125° of knee flexion. The radiological union of fractures was 4.4 months in our study. According to Neer’s score, 33 patients scored excellent to satisfactory. Conclusion: Internal fixation of fractures in the femoral shaft is an absolute must and has gained widespread acceptance as implants and technology have improved. The rationale for internal fixation is that it restores anatomical alignment and allows early mobilization of the patient and limb.
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Etiological profile of seizure in children of age group 1 month to 18 years with special reference to neuroimaging in a tertiary care hospital p. 368
Bikram Mondal, Oendrila Sarkar, Pankaj K Halder, Sukanya Deb, Debasree Guha, Amita S Mandal
DOI:10.4103/mgmj.mgmj_109_22  
Background: Seizure is a common cause of childhood hospitalization. Neuroimaging studies help in identifying etiologies, including the rare ones, and planning management. Purpose: The aim of this study is to determine the etiology of seizures in pediatric patients and the utility of neuroimaging in the same. Materials and Methods: A prospective study was carried out on 100 children who were admitted with seizures (including recurrent episodes) in our tertiary care institute. The sociodemographic profile, clinical features, neuroimaging findings, and findings of other investigations were documented and analyzed, to classify the type and etiology of seizures. Results: The male–female ratio among patients was 1.94: 1. Seizures of generalized onset were most common (95%), affecting mostly the age group of 1–5 years (50.53%), followed by the 5–18 years (29.47%) and the 1 month to 1 year (20%) groups. The etiologies were simple febrile seizure (51%), seizure disorder (8%), cerebral palsy (8%), acute viral meningoencephalitis (7%), pyogenic meningitis (6%), and complex febrile seizure (5%). Neuroimaging was carried out in 30 children, in which 14 showed abnormal reports, and abnormal electroencephalogram (EEG) report was found in 6 out of 10 patients. The analysis of the distribution of the types of seizures concerning age, gender, family history of seizure, history of seizure, socioeconomic status, and developmental milestones did not reveal any statistically significant relationships (P > 0.05). Conclusion: Seizure of generalized onset was the most common type, and the most common etiology was a simple febrile seizure. Abnormal neuroimaging/EEG findings were more pronounced in patients with focal seizures.
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Comparison of onset of action of Intrathecal Clonidine vs Intrathecal Fentanyl as an adjuvant with hyperbaric Bupivacaine and Bupivacaine alone under spinal anesthesia for lower limb orthopedic surgeries Highly accessed article p. 374
Aradhana Devi, Amrita Santosh, Archana Har, Jessy Vennel, Vikrant Gadkari
DOI:10.4103/mgmj.mgmj_113_22  
Background: Adjuvants are added to a local anesthetic solution to prolong the duration of analgesia. There is a paucity of studies comparing the onset of action of adjuvants like Clonidine and Fentanyl. In this study, the time of onset of action of intrathecal clonidine and intrathecal fentanyl as adjuvants to bupivacaine and bupivacaine alone were compared in the subarachnoid block for lower limb orthopedic surgeries. Materials and Methods: 90 adult patients posted for orthopedic surgery of the lower limb were divided into three equal groups of 30 each. Group A being the control group was given hyperbaric Bupivacaine(3ml) +0.5ml of Normal saline, Group B was given Intrathecal hyperbaric Bupivacaine (3 ml) +30 μg Clonidine and Group C was given Intrathecal hyperbaric Bupivacaine (3 ml) + Fentanyl 25 μg. The primary objective was to compare the time of onset of block and duration of analgesia. The secondary outcomes were the duration of sensory and motor block, duration of analgesia, hemodynamic parameters, and side effects. Results: The time of onset of the sensory blockade was 4.83 ± 0.64, 1.72 ± 1.47, and 3.4 ± 1.43 mins in groups A, B, and C respectively. The time of onset of the motor blockade as estimated by the time to reach level 2 on the Bromage scale, was 6.07 ± 0.55, 2.38 ± 1.32, and 5.06 ± 1.28 mins in groups A, B, and C respectively. The duration of postoperative analgesia was prolonged in the Clonidine group compared to the Fentanyl group. Conclusion: The study reveals that the time of onset of action of sensory and motor block was faster and the duration of analgesia was prolonged with adjuvants like Clonidine when compared to Fentanyl when added to Bupivacaine.
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A study to assess the effectiveness of warm foot bath therapy on the reduction of blood pressure among hypertensive patients attending a tertiary care setting p. 380
Arockiamary Ignasimuthu, Singaram Parimala
DOI:10.4103/mgmj.mgmj_132_22  
Background: The goal of hypertension management is to keep blood pressure within normal bounds while also enhancing elderly patients’ quality of life and health. Warm foot baths are a straightforward, affordable, and effective therapy method that can be used in naturopathy to alleviate hypertension. Materials and Methods: This study used a quasi-experimental design that included two groups, the hypertensive intervention group and hypertensive control group, which was studied over 3 months between March 2020 and May 2020. The necessary ethical committee permissions with reference number VMRF/2020/037 and informed consent from all the patients included have been obtained properly before proceeding with the study. Results: Among the 100 individuals involved in the study, 53% were males and 47% were females. The mean age among the intervention group was 53.62 ± 7.26, and 52.84 ± 6.47 among the control group. The majority of the males included in the study were nonsmokers (69.8%). The mean ± standard deviation of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the intervention group during the pretest phase was 157.3 ± 13.4 and 88.1 ± 9.4, whereas, after the intervention of foot bath therapy, the measurements of SBP and DBP were reduced significantly to 133.8 ± 9.7 and 76.9 ± 7.2, which was statistically significant with a P value < 0.001. Conclusion: Warm foot bath soak therapy is anticipated to be used as a nonpharmacological treatment for hypertension in older patients.
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Comparison conventional endoscopic myringoplasty with fibrin glue supplemented endoscopic myringoplasty p. 383
Rajendiran Devendiran, Nagabooshanam Mohanbabu, Venugopal Ravikumar
DOI:10.4103/mgmj.mgmj_131_22  
Introduction: The fibrin tissue glues have been used in many surgeries to reinforce surgical sutures and tissue adhesion. Myringoplasty is the commonly done ear surgery for the perforations of the tympanic membrane, where no suturing is done between remnant membrane and graft. Aim: The aim of the study is to compare the results and effectiveness of this biological fibrin tissue glue in myringoplasty surgeries as a supplementary procedure to conventional endoscopic myringoplasty (CEM) surgeries. Materials and Methods: Seventy patients with chronic suppurative otitis media with tympanic membrane perforation without ossicular and mastoid involvement have been chosen. One group of 35 patients underwent CEM surgeries. In another group of 35 patients, biological fibrin tissue glue, TISSEEL, has been used as supplementary to the CEM surgeries, and the graft uptake rate and hearing improvement were evaluated and compared postoperatively. Results: The graft success rate at 3 months postoperatively was 91.42% in both the groups, that is, 32/35, and these values were not statistically significantly different (P = 1.00). There was a highly statistically significant hearing outcome before and after the surgery in both the CEM and the fibrin tissue glue supplemented endoscopic myringoplasty groups. However, there was no statistically significant change in hearing outcomes between the two groups. Conclusion: In our study, we have got more or less similar results compared with the results of the studies on routine CEM cases. But the high-cost nature of the commercially available fibrin tissue glue makes it difficult to recommend for use in all routine endoscopy myringoplasty cases.
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Erosive Gastroesophageal reflux disease – are we missing pulmonary symptoms? p. 388
Saji Sebastian Kundukulangara
DOI:10.4103/mgmj.mgmj_127_22  
Background: Gastroesophageal reflux disease (GERD) is a common condition that affects about 20- 30% of the adult population, presenting with a broad spectrum of symptoms and varying degrees of severity and frequency. Extra esophageal manifestations like respiratory symptoms are being increasingly recognized. There are only very few studies on the prevalence of pulmonary symptoms in patients with erosive gastroesophageal reflux disease. Aim: The objective of the study was to determine the frequency of pulmonary symptoms in patients with erosive gastroesophageal reflux disease,Materials and Methods: This was a cross-sectional study done on 100 patients diagnosed based on upper gastrointestinal endoscopy findings. Patients were first interviewed about GERD symptoms using the GERD Health-Related Quality of Life questionnaire. Then the respiratory symptoms are assessed. Demographic details are recorded in a proforma. Pulmonary function tests were done on all the patients. Upper GI endoscopic findings are graded according to Los Angeles (LA) grading from A to DResults: The prevalence of pulmonary symptoms was 60%. The most prevalent symptom was a cough, then followed by dyspnoea on exertion, chest pain, wheezing, and snoring. There was a significant association found between LA grading and pulmonary symptoms like wheezing, cough, chest pain, and hoarseness of voice. No significant association was found between GERD duration and pulmonary symptoms. There was a statistically significant association found between LA grading and pulmonary function test. No association was found between quality of life scoring and pulmonary symptoms. Conclusion: There was a high prevalence of pulmonary symptoms in patients with erosive gastroesophageal reflux disease. Erosive GERD can affect pulmonary function according to severity. There was no association between prolonged GERD and pulmonary symptoms.
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Burden and determinants of substance abuse among urban adolescents of Shimla city: How vulnerable are our future citizens p. 392
Rakesh Thakur, Dineshwar S Dhadwal, Tripti Chauhan, Vijay Kumar Barwal
DOI:10.4103/mgmj.mgmj_51_22  
Background: Substance abuse is a major but neglected public health problem across the globe. Most of the time it starts during adolescence, which is also considered a critical risk period for the initiation of substance use. Materials and Methods: We conducted a cross-sectional analytical study to estimate the prevalence and determine the association of socio-demographic and other risk factors with substance abuse among adolescents in an urban area of Himachal Pradesh. A multi-stage cluster with probability proportional to size sampling technique was followed and a semi-structured, pretested questionnaire was used as the study tool. Results: We studied a total of 728 participants and 39.6% were females. The mean age was 15.6 ± 1.3 years. Out of these, 12.1% reported any substance abuse earlier in their lifetime. Among ever users, most commonly abused substance was alcohol (8.9%), followed by smoked tobacco (7.1%), bhang (3.7%), hard liquor (2.8%), charas/ganja (1.4%), chewing tobacco (1.4%), inhalants (fluid/eraser) 0.82%, prescription drugs (cough syrup/tablets 0.69% and injecting drugs 0.27%), Chitta (0.27%), opium and heroin with 0.14% each. On multiple logistic regression analysis, male gender (AOR=1.82), among friend’s tobacco smoking (AOR=2.33), alcohol abuse (AOR=4.52), and cannabis abuse (AOR=2.99) were found to be associated with an increased likelihood of substance abuse. High socio-economic status (AOR=0.59) and tobacco chewing among friends (AOR=0.49) had a protective effect on indulgence in substance abuse. Conclusion: The influence of peers played the most significant predictor while the presence of substance abuse in the family was also associated with an increased likelihood of abuse by adolescents.
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Evaluation of chemotherapeutic regimen and associated adverse drug reactions of colorectal cancer in a tertiary care hospital p. 400
Linda S Mol, Akash Jose, Arathy Mohan, CS Madhu, R Lakshmi
DOI:10.4103/mgmj.mgmj_112_22  
Background: Colorectal cancer (CRC) is the fourth most common cause of death diagnosed in both men and women. Though there are modifiable and non-modifiable risk factors for CRC. cancer patients encounter chemotherapy-associated drug interactions and adverse drug reactions hence the need for such a study will help the professionals to improve the patient’s quality of life. Materials and Methods: A six-month retrospective study of 130 patients who satisfied the inclusion and exclusion criteria was conducted by collecting data from November 2020 to May 2021. Data was collected from the Mediware system of the hospital using specially designed data collection forms. Results: Out of 130 patients, 61.51% were male and most of the patients were more than 60 years old. In this study, 11 patients had a history of smoking and alcoholism and 4% had a family history of CRC. Comorbidities associated with CRC were HTN and DM. In the study, stage 4 cancer patients were found to be more. 77.69% of patients had received chemotherapy along with surgery, and the most commonly prescribed regimen was Capcetabine and OxaliplatinThe length of hospital stay was increased for the FOLFOX (Oxaliplatin, 5-Fluorouracil, and Leucovorin) regimen. The common ADR analyzed was constipation, followed by vomiting and neutropenia, and most ADRs were associated with the CAPOX regimen (diarrhea) and treated accordingly.10 patients had febrile neutropenia, 5 patients had grade 4 neutropenia and all were treated with antibiotics and filgrastim. Febrile neutropenia was seen in patients with metastasis. Conclusion: Timely and appropriate treatment for ADRs and early screening can improve the quality of life of individuals. Further studies on this topic will help to improve the treatment quality provided by professionals
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REVIEW ARTICLES Top

Copper-based fabric for healthcare professionals to prevent healthcare-associated infections: A futuristic/dreamed uniform p. 406
Megha Sharma, Shatrughan Pareek
DOI:10.4103/mgmj.mgmj_44_22  
Healthcare-associated infections (HAIs) have a major impact on public health worldwide. Till now, we are relying on hand washing and environmental disinfection, but the compliance rate of hand washing and adequate supply of materials is always a catch. Alongside patients, surfaces and supplies act as reservoirs of microorganisms in healthcare settings. The reduction in organisms may prove to be an effective strategy to decline HAIs. The use of gold and silver in commercial textiles is prohibited because of the high cost rather than having excellent antibacterial and antimicrobial properties, so copper has become the best choice for researchers as it possesses similar properties to gold and silver and has other characteristics such as its durability, corrosion resistance, prestigious appearance, and ability to form complex shapes. It has been found that copper brings down the microbial burden of high-touch surfaces in healthcare settings. The fundamental properties of copper offer a theoretical advantage to regular cleaning, as the effect is continuous rather than episodic. So the use of copper-impregnated textiles in hospital areas whether in form of bed linen or uniforms for health professionals, as well as patients, can be a viable alternative to decline the levels of infection in healthcare settings, and with the discovery of copper-encapsulated hospital beds and fabrics, dividends will likely be paid in improved patient outcomes, lives saved, and healthcare cost saved. The application of copper in fabrics for healthcare professionals will be a sound initiative to prevent HAIs. The fabric may help decline the infection rate and mortality among hospitalized patients.
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A review of the physiological effects of Suryanamaskar in children p. 410
Abhijeet K Kanojia, Hiranmayee S Bagwe, Bela M Agarwal
DOI:10.4103/mgmj.mgmj_106_22  
Increasing physical inactivity in children necessitates the exploration of physical activities that can confer health benefits. The purpose of this study was to review the literature regarding the physiological benefits of Suryanamaskar, a composite yogasana on physical fitness in children. Primary source articles in English, published between 1980 and 2020, in peer-reviewed journals were included. A literature review was carried out using PubMed, Cochrane-Library, Science Direct, and Google Scholar databases. Keywords used were “Suryanamaskar,” “physical fitness,” “sun-salutation,” “physiological effects,” “physical activity,” “health promotion,” “yoga,” and “children.” The methodological quality of the studies was assessed using the Physiotherapy Evidence Database scale. The effect of Suryanamaskar training on physical fitness components, namely flexibility, muscle strength, cardiorespiratory endurance, and cognition, was reviewed. Seven studies matched the inclusion criteria. All seven studies were randomized controlled trials. The level of evidence was of fair quality with a high risk of bias. Following Suryanamaskar intervention, improvement in musculoskeletal function—muscle strength and endurance, and the flexibility of hip joint, wrist joint, hamstrings, and dorso-lumbar fascia were reported. Improvements in cardiorespiratory variables such as peak expiratory flow rate forced vital capacity, forced expiratory volume, vital capacity, and reduction in blood pressure and heart rate are reported in children. Improvements in cognition were also observed following Suryanamaskar’s intervention. Suryanamaskar training confers health benefits and improves physical fitness components such as muscle strength, flexibility, cardiorespiratory endurance, and cognition. Suryanamaskar can emerge as a useful tool to increase physical fitness, deter physical inactivity, and promote healthy behavior (sanskar) in school-going children. High-quality longitudinal randomized control trials need to be undertaken to confirm the same.
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Nanopolyphenols: Perspective on oxidative stress-induced diseases p. 419
Priyanka Rathod, Raman P Yadav
DOI:10.4103/mgmj.mgmj_100_22  
Recently nanopolyphenols are gaining widespread interest in the drug discovery domain. Nanonization of polyphenols has greatly affected the therapeutic index owing to improvement in pharmacokinetic and biopharmaceutical obstacles linked with the use of natural polyphenols. They have been looking at an emerging paradigm for an array of disease symptoms. In this article, we have explored the therapeutic potential of nanopolyphenols in oxidative stress-induced diseases such as neurodegeneration, cancer, obesity, and diabetes. This article will present the current state of the art of various nanopolyphenols targeting oxidative stress-induced diseases. The advanced fabrication strategies presented for polyphenols including nanocrystal, mesoporous silica nanoparticles, nanoparticles, nanoliposome, gold nanoparticle, and nanosuspension are discussed. The information presented in light of recent in vitro, in vivo, and clinical evidence for nanoformulation and delivery of polyphenols may show a new dimension to future research in the realm of herbal therapy for oxidative stress-induced diseases. Significant information on the molecular mechanisms underlying linkages of oxidative stress with neurodegenerative diseases, cancer, obesity, and diabetes is discussed. Valuable information on dietary polyphenols in these diseases and their clinical data is presented. Based on different experimental evidence, the review findings support phenomenal therapeutic strategies for nanopolyphenolic fabrication with extended benefits and a condensed time frame. The status of clinical trials conducted on nanopolyphenols is presented. Although clinical trials conducted on nanopolyphenols for mentioned diseases are few, we have tried to present as much available clinical data in this article.
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CASE REPORTS Top

Multisystem inflammatory syndrome in neonate with skin lesions—A rare case report p. 431
Sanmithra P K Arunakumar, Raghunadan B G Krishnamurthy Rao, Lakshmipathy S Rajagopaliah, Sujatha Ramabhatta
DOI:10.4103/mgmj.mgmj_107_22  
Multisystem inflammatory syndrome in children is a serious condition that occurs due to postinfectious immune-mediated hyperinflammatory reaction seen in children, which develops after 4–6 weeks of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection; it is rare in neonates. We present here a case of a term newborn with fever, respiratory distress, and necrotic skin lesion that gradually progressed to multisystem dysfunction. Reverse transcription polymerase chain reaction for SARS-CoV-2 was negative for both mother and the baby. SARS-CoV-2 IgG titer was negative in the mother but was found to be positive in the newborn. The diagnosis of multisystem inflammatory syndrome in neonate was made and was successfully treated with intravenous immunoglobulin and corticosteroids.
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A case report of skeletal fluorosis leading to cervical compressive myelopathy and a review of literature p. 435
Abhishek Singhai, Vishnu N Mishra, Vaibhav Ingle
DOI:10.4103/mgmj.mgmj_92_22  
Fluorosis is a public health problem that is caused by excess intake of fluoride through ground/deep bore water. It gets deposited in the bones, teeth, and soft tissues. Fluoride in the human body acts as a “double-edged sword.” Fluoride is beneficial in small amounts but toxic in large amounts. People who have consumed 10–20 mg of fluoride per day for more than 10–20 years may develop crippling skeletal fluorosis. Stiffness and pain in the major joints, including the neck, back, hips, and knees, reduce mobility. The bone structure may change and ligaments may calcify in extreme cases, resulting in muscular weakness and pain. Here, we have reported a case of chronic quadriparesis due to compressive cervical myelopathy. After extensive workup, diagnosis of skeletal fluorosis was made.
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An unusual case of methemoglobinemia resulting from self-administration of nitrobenzene in a psychiatric patient p. 439
Chanjal Koonampadan Sathyan, Harihara Sudhan Chidambaram,, Melvin Dominic, Syed Abthahir Sirajudeen, Venkata Durga Prasad Jinka
DOI:10.4103/mgmj.mgmj_129_22  
Nitrobenzene, when consumed in large enough doses, can cause methemoglobinemia. By reducing oxygen unloading and oxygen binding, methemoglobinemia reduces oxygen delivery. This is a case of 55-year-old man who is a known case of psychiatric disorder was brought to the emergency room with an alleged history of deliberate consumption of nitrobenzene liquid approximately 10 mL in the morning of the day at his residence. He also instilled 2 drops in the right ear and was taken to a private hospital where the initial management with gastric lavage, multidose activated charcoal and methylene blue was given. He was then referred to the government tertiary care setting for further management. Prompt intravenous methylene blue treatment increases PaO2 in patients with methemoglobinemia.
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LETTER TO THE EDITOR Top

Menace of violence against doctors—Its possible solutions p. 442
Harish Gupta
DOI:10.4103/mgmj.mgmj_86_22  
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ORIGINAL ARTICLES Top

Correlation of resting scapular position and functional throwing performance index among amateur basketball players: An observational study  
Reema Joshi, Varun Pohekar
DOI:10.4103/mgmj.mgmj_54_22  
Background: Scapular dyskinesis is prevalent in 54.5% of overhead athletes. Scapular dyskinesis is abnormal positioning of the scapula over the thorax and also abnormal motions of the scapula. Any alterations to the normal scapular position may alter the accuracy of striking and serving in basketball players. This study aims to find out the relation between the resting scapular position and the throwing accuracy of players. Results: The research suggests that there is a moderate correlation present between the resting scapular position and the throwing accuracy of the players. Conclusion: In this study, results state that the resting position of the scapula plays an important role in power generation and biomechanics of throwing in overhead athletes affecting the throwing accuracy of players.
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