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ORIGINAL ARTICLES
CT chest interpretation of novel coronavirus disease (COVID-19): Our experience with the first 60 patients at MGM Medical College, Aurangabad, India
Bano Nikhat, Meghana Deshmukh, Devidas B Dahiphale, PS Mishrikotkar, Saurabh Joshi
January-March 2021, 8(1):9-14
DOI:10.4103/mgmj.mgmj_78_20  
Introduction: In December 2019, the outbreak of a novel corona virus infection occurred in Wuhan City, China. Early discussions suggested that computed tomography (CT) should be the preferred modality for the diagnosis of COVID-19. However, the use of CT for COVID-19 diagnosis is controversial. Also, the detailed CT features of COVID-19 have been reported in only a small number of articles in the literature. Objective: To evaluate lung abnormalities on thin-section CT scans in patients with COVID-19. Materials and Methods: This study included the first 60 clinically suspected patients for COVID-19 infection. The patients have further investigated for COVID-19 infection by reverse transcription-polymerase chain reaction (RT-PCR) test and CT chest. We identified CT patterns suggestive of COVID-19 infection and calculated the total CT severity score. The imaging reports of the CT chest study were compared with the RT-PCR test results. Results: In our study, we had 37 male patients and 23 female patients. COVID-19 pneumonia was diagnosed in 55 of the 60 patients, but five patients did not show any commonly described findings of COVID-19 pneumonia. Of the 55 patients, the majority of them had ground-glass opacities. The bilateral lower lobes were involved in the majority of the cases. RT-PCR results show that, of the 60 patients, 37 were positive for COVID-19 and 23 were negative for COVID-19. The mean total lung severity score for the 60 patients was 11.5 (range, 0–25). Mediastinal lymphadenopathy was notably absent in all 60 patients and only five patients had traces of bilateral pleural effusion and only one patient had air trapping. In terms of the distribution of disease in the axial plane, peripheral distribution was found in most of the cases. The patients with higher CT scores required ICU admission and ventilator support, and had a poor prognosis. Conclusion: We found that chest CT may be useful as a standard method for the rapid diagnosis of COVID-19 to optimize the management of patients in hospital settings where nucleic acid testing kits are not available or available in limited quantities. Chest CT plays a crucial role in the early detection of COVID-19, particularly for those patients with a negative RT-PCR.
  14,910 212 -
EDITORIAL
COVID-19 pandemic: Only views, counter views, and reviews, no clear-cut answers yet
Sushil Kumar
January-March 2020, 7(1):1-4
DOI:10.4103/mgmj.MGMJ_46_20  
  9,026 259 1
REVIEW ARTICLE
Human vaccines industry in china, 2019: Part II
Prasanta Kumar Ghosh
April-June 2020, 7(2):86-96
DOI:10.4103/mgmj.MGMJ_48_20  
There are a large number of private manufacturers of vaccines in China. Most of the Chinese private companies manufacturing vaccines were established in the decade of 1990 and thereafter. Local investors came forward to set up manufacturing facilities in an environment of China’s growing demand for human vaccines and for exports. There are at present about 34 companies operating in the private sector, including MNCs. In this review, profiles of 25 private Chinese companies have been brought out. The turnover of vaccines manufactured in China is estimated at between US$3.50 and US$3.95 billion in 2019. Although the turnover of the vaccine industry was about 2.7%–3.1%, when compared to its pharmaceutical industry in value terms, it is a very important segment of healthcare infrastructure of the country.
  5,754 235 -
CASE REPORTS
Intrauterine fetal death due to true knot on umbilical cord: Report of two cases
Bhoomika Jain, Rahul Khatri, Devadatta Dabholkar, Sushil Kumar
January-March 2020, 7(1):46-49
DOI:10.4103/mgmj.MGMJ_43_20  
The incidence of a true knot of the umbilical cord is not only very low ranging from 0.3% to 2.1%, but also it often remains undiagnosed antenatally despite the availability of ultrasonography (USG). If the true knot remains tight, it may impede the circulation of the fetus and results in intrauterine fetal death (IUFD). We reported two cases of the true knot of the umbilical cord that ultimately led to fetal demise. Our first patient was a 25-year-old primigravida, with a singleton pregnancy of 35 weeks reported with complaints of absent fetal movements for the day. On examination, the patient was normotensive; the fundal height corresponded with the gestational age. The fetal heart sounds were absent on auscultation. The ultrasound confirmed IUFD. Labor was induced and the patient underwent uneventful vaginal delivery. However, the baby was stillborn. Two tight loops of the umbilical cord around the neck with true knots were found. Our second patient was gravida 2 with previous cesarean delivered 3 years back. She was pregnant 25 weeks and had a loss of fetal movement for the day. The fetal heart sounds were absent. She went into spontaneous labor and delivered vaginally. On examination, the true knot in the umbilical cord was seen.
  5,007 200 -
REVIEW ARTICLE
Human Vaccines in India: Present and Future Perspectives
Prasanta Kumar Ghosh
July-September 2019, 6(3):137-147
DOI:10.4103/mgmj.mgmj_11_20  
Vaccines are formulations that equip the human immune system to fight against a pathogen. All the vaccines approved for use are safe. On vaccination, the body produces enough clonal B and T cells to resist infection. Vaccines are the most cost-effective defense against infectious diseases. In India, there are at least 19 manufactures of vaccines. In addition, there are also a large number of companies that import specific vaccine formulations and sell these in India. These include two multinational companies that have also established repacking facilities. India has a well-established Universal Immunization Program (UIP) that targets vaccination of 30 million pregnant women and 27 million newborns annually. Indian vaccines are available at affordable prices to the private consumers but are supplied free of cost to the Indian beneficiaries through the UIP. Several kinds of vaccines technology are being researched all over the world. India has concentrated on the production and supply of conventional vaccines at cost-effective prices. India is also engaged in some level of research at manufacturing companies as well as at the institutional level. Effective vaccination of pregnant women and children would translate into a generally more healthy and productive society globally. India is poised to contribute in such an endeavor.
  4,367 313 -
Human vaccines industry in China, 2019: Part—I
Prasanta Kumar Ghosh
January-March 2020, 7(1):35-45
DOI:10.4103/mgmj.MGMJ_27_20  
China is presently the most populous country; the annual birth rate is estimated at above 18 million each year over the next 5 years. The number of the aged population is also increasing. Continuous in-country demand for vaccines will, therefore, be maintained, providing opportunities for the manufacturers. China produces a large number of vaccines, presently estimated at 55 different types, which are used to protect against 28 types of individual infectious microbial diseases. The country has presently a total of 41 vaccine manufacturing companies, of which 21 are the major ones. The manufacturing capacity appears to be over 1000 a million doses per annum and the annual production in 2019 was over 700 million doses. Chinese imports of vaccines have remained low. The major government establishment, the China National Biotec Group (CNBG) companies are the leading manufacturer of vaccines in China and supply more than 50% of all the vaccines consumed in the country. CNBG is a research-driven biotech establishment and is engaged in R&D, manufacturing, marketing, and distribution of vaccines and blood products. CNBG has six institutes of biological products besides other assets; the six institutes are also engaged in the manufacture, distribution, and sale of vaccines through their manufacturing companies and establishments in China. CNBG has seven vaccine manufacturing units. CNBG is a subsidiary of China National Pharmaceutical Group Corporation (Sinopharm). Sinopharm infrastructure shoulders the social responsibility of Chinese national medical and pharmaceutical reserve on a sustainable long-term basis, including handling of emergency situations. Sinopharm is under the State-owned Assets Supervision and Administration Commission (SASAC) of the State Council of China and is engaged in 10 core business activities that cover biopharmaceutical products, including vaccines.
  4,347 322 1
ORIGINAL ARTICLES
Efficacy of daily oral terbinafine versus pulse fluconazole therapy in the treatment of tinea corporis, tinea cruris, and tinea faciei: A comparative study
Pranjal Salunke, Shylaja Someshwar, Mayur Bhobe
January-March 2020, 7(1):10-15
DOI:10.4103/mgmj.MGMJ_30_20  
Introduction: Both terbinafine and fluconazole are effective systemic drugs for dermatophytosis. They can be used intermittently as pulse doses or as daily doses for the treatment of the same. Aim: The aim of this study was to assess the efficacy and safety of 1 week twice a day therapy of terbinafine and to compare it with that of a daily 2-week course of terbinafine and weekly pulse fluconazole therapy. The adverse effects and relapse rates after the completion of therapy were assessed. Materials and Methods: A study was conducted with 90 patients divided into three Groups A, B, and C. Patients were assessed at 2 and 4 weeks of starting treatment and 6 weeks following the completion of treatment. Adverse effects if any were noted. Clinical scores were calculated, and skin scraping for potassium hydroxide (KOH) examination was done. Clinical improvement was assessed. A mycological cure is defined as a negative KOH examination. Results: There was a significant decrease in clinical scores before treatment and at 2 and 4 weeks of visits. The highest clinical cure rates were attained in Group A (80%), followed by Group B (73.33%) and Group C (63.3%). Mycological cure rate at 4 weeks was highest in Group A (93.3%), followed by Group B (86.7%) and Group C (83.3%). This difference in clinical and mycological cure rates in the three groups was not found to be statistically significant. Of the patients who had responded to treatment at 4 weeks, the clinical and mycological cure was maintained in 96.4% individuals in Group A, 96.1% in Group B, and 88% in Group C at 6 weeks. Thus, the highest number of recurrences was seen in Group C, followed by Group B and Group A. All the three treatment regimens were well tolerated. Side effects were seen in 17 patients. They were mild and predominantly gastrointestinal. Conclusion: All three drugs in different regimens were found to be equally efficacious in the treatment of dermatophytic infections in our center.
  4,130 289 1
Prevalence of musculoskeletal symptoms and quality of life in housekeeping workers of a tertiary care hospital in Navi Mumbai, India: A descriptive study
Palak Chheda, Swapna Rajan Sreeraj
July-September 2020, 7(3):133-140
DOI:10.4103/mgmj.mgmj_26_20  
Context: Prevalence of musculoskeletal disorders (MSDs) in India is 90%, leading to loss of working hours, poor quality of life (QoL), and reduction in productivity of the life of the employers. Housekeeping profession, considered a major workforce industry, requires manual labor demanding awkward postures and repetitive movements, leading to MSDs and impacting QoL. Objectives: The objective of this study was to find the prevalence of the symptoms of MSDs and QoL in the housekeeping workers of the hospital. Settings and Design: A descriptive study was carried out among housekeeping workers of MGM Hospital, Kamothe, Navi Mumbai, Maharashtra, India. Materials and Methods: With Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) and WHO-QOL-BREF scale, 82 housekeeping workers were contacted, and an interview-based session was held. Statistical Analysis: Descriptive analysis and graphical representation were carried out using MS Excel. Results: Of the participants, 68.29% were females with a mean age of 42.28 ± 7.4 years, and 31.70% were males with a mean age of 42.04 ± 8.3 years. The prevalence of the symptoms of MSDs was higher in knees followed by lower back and lower leg. Females (80.36%) were affected more than males (61.54%). WHOQOL-BREF for QoL showed a moderate impact without much gender difference. Conclusion: The study concluded that there is a high prevalence of the symptoms of MSDs in housekeeping staff, more likely in the lower back, knee, and lower leg, and WHO QOL-BREF shows comparable mean scores among males and females.
  3,859 293 1
EDITORIAL
Resident doctors’ duty hours: A questionnaire-based study in national and international perspective
Sushil Kumar, Akriti Gupta
July-September 2020, 7(3):105-109
DOI:10.4103/mgmj.mgmj_70_20  
Introduction: Most serious patients among the poorest of the poor class are treated in the hospitals attached to medical colleges. Although there are senior and experienced doctors available, there is no denying the fact that resident doctors are the backbone of medical care. We cannot even dream of running these hospitals without them especially when coronavirus disease-2019 (COVID-19) is spreading like a wildfire across the globe. As far as the mental health of the resident doctors is concerned, often there are complaints of burnouts, depression, medical error, suicidal ideation, and leaving the course halfway, among them. We carried out a small questionnaire-based study to find out the viewpoint of the residents. Materials and Methods: An anonymous survey in respect of work hours and call schedules was administered to 50 junior residents. The results were analyzed. The faculty viewpoint, regulations in different countries, and regulatory bodies were also taken into account to present a balanced view and recommendations. Results: A total of 50 residents were surveyed. 64% of the residents worked for around 81–100h per week. 58%residents get 6h of uninterrupted sleep per day. 86% of the residents felt that extended working hours do not improve patient care. 82% of residents felt that there is no gain of skills with extended working hours; also, it does not leave them any spare time to study. 64% of the residents (mostly first-year postgraduate [PG] students) felt that most of their time is used for paperwork, which has no bearing on their skill development or knowledge. 16%–24% of residents felt that the extended working hours are affecting their mental health. Some of the residents felt that their relationship with coresident also affects their work. 74% of the residents admitted that they were asked to work more than 24h continuously quite often. 84% of the residents felt that they should get more time for leisure activities. Conclusion: There is a need to formalize working hours and to reduce paperwork for the residents to keep them in good mental health. A structured and supervised work schedule for the residents especially for the first-year PG students is the need of the hour. We need to balance education, patient care, and health of the young resident doctors while considering their work schedule.
  3,741 276 1
ORIGINAL ARTICLES
Reconstruction of scrotum with anteromedial thigh flap
Anuradha J Patil, Avinash Yelikar, Aakanksha Vichare, Tanvi Tolat, Jiten Kulkarni
October-December 2019, 6(4):165-170
DOI:10.4103/mgmj.mgmj_18_20  
Background: Reconstruction of extensive defects of the perineum and scrotal region, with exposure of the testes, following avulsion injury or severe infections represents a significant challenge. Replacement with sensate, durable cover is mandatory for functional, cosmetic, and psychological reasons. A wide range of flap techniques has been reported for this purpose with their advantages and disadvantages. We describe the use of the anteromedial thigh flap in our case series with the advantages and disadvantages. Materials and Methods: We had seven patients in our series, of which two patients were posttraumatic defects and other five were post-Fournier’s gangrene unilateral scrotal defects. We describe few case examples in the series in detail, of which the first patient was 21-year-old labor who presented with avulsion injury to penis and scrotum. He had a loss of scrotal skin near totally, except for 2cm × 2cm areas posteroinferiorly. In addition, he also had a loss of penile skin from the glans to the base of the penis. We used bilateral anteromedial thigh fasciocutaneous flap based on the longitudinal axiality of the anteromedial thigh suprafascial plexus for reconstruction. The patient had an excellent recovery, a good aesthetic result at the end of 1 year. Another posttraumatic defect was unilateral and the patient also had a good recovery.The other five patients in series were of Fournier’s gangrene. All patients underwent initially debridement and then flap cover on day 7. All of them needed unilateral scrotal reconstruction. The unilateral anteromedial flap was carried out with good recovery at the end of the 6 weeks. Results: This flap has provided nice durable cover for the testes with an acceptable aesthetic appearance, although the color match was not good in case 3 of the series. Conclusion: In conclusion, anteromedial fasciocutaneous thigh flap is a good choice for scrotal reconstruction that could provide a sensate, durable cover that fulfills patient satisfaction. It is technically easy and has favorable functional and aesthetic results.
  3,419 226 -
Knowledge, acceptance, and hesitancy of COVID-19 vaccine among health care workers in Nigeria
Ebbi Donald Robinson, Peace Wilson, Beneboba Jenewari Eleki, Woroma Wonodi
April-June 2021, 8(2):102-110
DOI:10.4103/mgmj.mgmj_4_21  
Introduction: Health Care Workers are major influencers in vaccination, thus their acceptance or hesitancy to the covid-19 vaccine would either aid its acceptance among the populace. Materials and Methods: The study was a cross-sectional survey using a self-administered questionnaire from December 15, 2020 to January 10, 2021 among healthcare providers living in Nigeria. The questionnaire was made up of segments that include demographics information, knowledge of the COVID-19 vaccine, its acceptance or hesitancy. The questionnaire was fashioned using Likert scale multiple questions of three options: YES, NO, and I Don’t know (No opinion) and Aware, Somewhat aware, and Not aware. Data collected were entered into the spreadsheet using IBM SPSS version 22.0 statistical software and analyzed with descriptive statistics. The results were presented as percentages, frequency, tables, and figures. Results: A total of 1094 responses were retrieved. The majority are males (56.67%) with 36.93% of the respondents aged 30–39 years. PHC Worker forms 14.90% of the respondents and social media was the greatest source of information. A percentage of 45.74% have no confidence in the vaccine and 39.68% rejecting, the majority been males (47.38%). The reasons for hesitancy are concerns of effectiveness, side effects, fear of the unknown, and safety. The highest rejection was by Dental Technicians (53.03%) while the highest acceptance was Medical consultants (72.22%). Conclusion: The study shows that about 3 out of every 10 health workers showed COVID-19 vaccine hesitancy for various reasons. The study recommends effective education, training, and public enlightenment to change the narrative.
  3,282 330 4
In silico drug repurposing: An antifungal drug, itraconazole, repurposed as an anticancer agent using molecular docking
Sanika Dhorje, Poonam Lavhate, Amrita Srivastav
July-September 2020, 7(3):110-118
DOI:10.4103/mgmj.mgmj_31_20  
Introduction: In recent years, increased cancer incidences and death rates due to it, have turned cancer to be a major problem worldwide. Approximately more than 7 million people globally die from cancer. Among the various types of cancer, breast cancer is the most prevalent type of malignant neoplasms among the women. Owing to the increasing triple-negative breast cancer (TNBC) cases per year, there is a high demand for the development of new potential drugs within a short period. Objectives: The objectives of this study were to overcome the traditional drug discovery challenges and to deal with hazardous diseases with potential drugs within a less time using molecular docking as the most important bioinformatics tool used for computer-aided drug designing (CADD). Materials and Methods: For designing drug against TNBC, Smoothened (SMO) protein involved in the hedgehog pathway is selected, and an antifungal agent itraconazole is taken as a drug, which already exists but is repurposed using bioinformatics tools such as National Centre for Biotechnology Information (NCBI), Protein Data Bank (PDB), KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway database, Computed Atlas of Surface Topography of proteins (CASTp)/metaPocket, PubChem, DrugBank, MarvinView, Discovery Studio, and AutoDock tool. Similarly, the effect of the drug was tested in vitro on TNBC cell line (MDA-MB-231) using 3-(4, 5-dimethythiazol-2-yl)-2, 5-diphenyl tetrazolium bromide (MTT) assay. Results: It was observed that cell viability decreased when different drug concentrations were used against TNBC cell lines in vitro as compared with the control sample, which lacked the drug sample. The cell viability observed was 100% in the control sample, 91% in 15.625 µM drug concentration, 71.5% in 31.25 µM drug concentration, 65.25% in 62.5 µM drug concentration, 54.75% in 125 µM drug concentration, 40.5% in 250 µM drug concentration, and 43% in 500 µM drug concentration. Conclusion: Repurposing of drug with the help of molecular docking is an effective method of drug development, which reduces time and cost of development of drug, and as it has already been approved, its safety measures are already known to make them safe to use. It is concluded that itraconazole shows an inhibitory effect on SMO, and thus it can be used as an anticancer agent.
  3,279 291 -
Practical skills evaluation of undergraduate medical students by an objective structured practical examination (OSPE): An effective tool for formative assessment in microbiology
Gurjeet Singh, Raksha Singh
April-June 2020, 7(2):74-78
DOI:10.4103/mgmj.MGMJ_45_20  
Background: Objective structured practical examination (OSPE) has ended up being a decent choice to beat traps of customary technique for evaluation. OSPE is not typically used in medical colleges in India in view of requirements of assets. Consequently, the two teachers and students are very little mindful of the OSPE model. Consequently, we led this examination to make mindfulness on the OSPE strategy and break down Student’s assessment with respect to the technique. Aims and Objectives: This study was conducted to know how the subjectivity of conventional practical methods of evaluation in medical education is overcome in OSPE. Materials and Methods: A total of 130 second-year professional MBBS students were included in the study. The skills of the medical students were assessed on the basis of their performance. Four stations were formed, of which two were procedure stations and other response stations. Students were evaluated using the OSPE model. OSPE additionally broke down to see the lacuna in any progression or any inquiry with respect to students. Traditional techniques and procedural and response stations in OSPE were investigated to learn the knowledge, skill, and competency of students in this subject. Student’s opinion about the new method was collected through a questionnaire and analyzed. Results: A total of 130 students from MBBS’ second professional year were included in the study. Of which, 91.54% of students felt that they were given adequate time at each station adequate, 71.54% responded that they were prior sensitized about OSPE, 93.08% responded that the exam was not stressful, 94.62% said that the OSPE was very much organized, applicable, and uniform, 80.77% said that the exam covers the appropriate knowledge than the traditional examination, and 76.15% opined that such type of exams should be included in the future as a method of formative assessment in practical examination. Conclusion: It was proved in this study that OSPE had overcome the subjectivity in conventional methods. The students showed lacunae in some steps of the exercise, which were informed to the teachers for more concentration on those steps. The students had good knowledge and skills but less competency, our study highlights the implementation of OSPE for formative assessment in the curriculum of undergraduate medical education, so that students can achieve more skills and knowledge to improve their competency.
  3,105 232 -
Adverse cardiovascular effects of betel nut
Sayed Md Mumtaz, Ramesh K Goyal, Shridhar Dwivedi
October-December 2019, 6(4):171-174
DOI:10.4103/mgmj.mgmj_20_20  
Background: Areca nut (Areca Catechu) is considered to be the fourth extremely prevalent addictive psychoactive substance consumed widely by about 10%–20% of the world population. Due to its theological and cultural acceptance, areca nut is chewed in different forms and formulations. It has been observed that people who chew supari (areca nut) exclusively for many years suffer from diabetes mellitus, coronary artery disease (CAD), oral submucous fibrosis, and oral cancer. We, therefore, planned to see its association with various cardiovascular ailments at our center. Materials and Methods: This was a single-center observational study carried out on people chewing areca nut exclusively (no other toxic or addicting substance) attending cardiac outpatient department (OPD) in National Heart Institute and Research Centre, Delhi, India. The subjects data were collected regarding the history of the disease, consumption of areca nut, and socioeconomic status with relevant work up. Results: There were 17 subjects who primarily chewed areca nut; 11 of them had CAD, diabetes, oral submucous fibrosis, and aplastic anemia. Further, one particular case not only suffered oral cancer but also had two episodes of myocardial infarction, but continued to chew areca nut. The second episode of myocardial infarction was fatal. Conclusion: Areca nut chewing is also associated with significant cardiovascular morbidities besides oral cancer. In such preparations, the risk of some other toxic substances together with areca nut cannot be eliminated as no empirical analysis has been carried out to the best of our knowledge and belief. In order to clarify its effect on other vascular diseases, further work with a larger sample size is required.
  3,083 238 -
Serum lipid profile in patients with cholesterol containing gallstones: A study from South India
Prema Saldanha, Priya Suneja, Anand Raj
April-June 2020, 7(2):63-67
DOI:10.4103/mgmj.MGMJ_42_20  
Background: Cholelithiasis is a common disease and notable advances have been made in studying the possible causes and mechanisms involved. It is not only important to study the prevalence of gallstone disease regionally, but also to explore the demographic and biological markers related to the development of gallstone disease, so that appropriate preventive measures may be undertaken. Many previous studies have shown a positive correlation between altered lipid profile and formation of gallstones, whereas some show no definite correlation between the two. Objective: This work aimed to study the association of lipid profile with cholelithiasis in our geographic region. Materials and Methods: This was a retrospective study of cases who underwent cholecystectomy for cholelithiasis, obtained from the archives of the Department of Pathology. The lipid profiles of these patients were retrieved from the laboratory records and analyzed. Results: The number of patients with mixed stones (cholesterol and pigment) accounted for 85% and pure cholesterol stones were seen 15% of the cases. Deranged lipid profile was observed in 57 (95%) of the cases. The most common abnormality was increased levels of low-density lipoprotein /very low density lipoprotein with decreased high-density lipoprotein. Conclusion: In this study, it was found that a significant number of patients with cholesterol-containing stones had a deranged lipid profile. This suggests that hyperlipidemia plays an important role in the lithogenesis of cholesterol-rich gallstones.
  3,002 228 -
Diagnostic pitfalls in the fine needle aspiration cytology of the breast
Prema Saldanha, Farhana C Kannoli
January-March 2020, 7(1):5-9
DOI:10.4103/mgmj.MGMJ_40_20  
Background: Fine needle aspiration cytology (FNAC) of the breast is a reliable, simple, minimally invasive, cost-effective procedure with high sensitivity, specificity, and diagnostic accuracy. It is commonly used for the assessment of breast lesions and as a guide to preoperative evaluation and management. Objective: The objective of this study was to assess the accuracy of fine needle aspiration of the breast and critically evaluate the cases, which showed discordance between cytology and histopathology. Materials and Methods: This is a retrospective study of cases of FNAC done for breast lumps. The slides were retrieved from the archives of the Pathology Department. Breast cytology findings were reported according to the six standard categories—positive for malignancy, suspicious for malignancy, atypical, proliferative without atypia, benign/unremarkable, and unsatisfactory. The FNAC findings were correlated with the histopathology diagnosis. Cases showing cytological and histological disparity were reevaluated for the detection of possible causes of the discrepancy. Results: The study consisted of 100 cases. For the diagnosis of carcinoma, the sensitivity was found to be 92.9%, specificity was 100%, positive predictive value was 100%, negative predictive value was 97.2%, and the total accuracy was 99%. False positives were not seen, and two cases were false negatives. Suboptimal material, lack of extensive sampling, and absence of all the characteristic features caused under diagnoses were recognized as common pitfalls. Conclusion: This study highlights the causes of cytological pitfalls. Strict adherence to the proposed criteria and extensive sampling of the lesions are of paramount importance in reducing the number of false-positive and false-negative cases.
  2,940 242 -
CASE REPORTS
Hemoglobin-D Punjab—rare hemolytic anemia in the elderly: a case report
Tushar Kanti Biswas, Anupa Pillai
July-September 2019, 6(3):148-151
DOI:10.4103/mgmj.mgmj_12_20  
A 62-year-old woman with no comorbidity presented with dyspnea since 2 months and fatigue since 1 month. She was having severe anemia with hepatosplenomegaly and icterus. Anemia due to blood loss was ruled out. With a history of blood transfusions and episodes of jaundice in the past, evaluation of hemolytic anemia was carried out. Her serum iron level was normal. Serum lactate dehydrogenase level was raised, and extracorpuscular causes were absent. Hemoglobin electrophoresis was performed in view of suspected hemoglobinopathy. It showed hemoglobin-D Punjab homozygous type, which is very rare. Its presentation in older age is even rarer to warrant this report.
  2,959 207 -
EDITORIAL
The impact of COVID-19 pandemic on reproductive health care for women
Sushil Kumar
October-December 2020, 7(4):163-165
DOI:10.4103/mgmj.mgmj_86_20  
  2,880 277 -
ORIGINAL ARTICLES
Patterns of culture positivity and antifungal sensitivity in dermatophytosis
Vedant Ghuse, Shylaja Someshwar, Hemangi Jerajani
July-September 2019, 6(3):105-112
DOI:10.4103/mgmj.mgmj_4_20  
Background: Antifungal drug resistance and a lack of clinical response in 20% of cases of dermatophytosis calls for an evaluation of resistant dermatophytes using a standardized simple and reproducible in vitro assay, to allow clinician to select the appropriate antifungal agent based on the susceptibility of the isolate to the antifungal agent. Objective: The objective of this study was to clinically correlate the patterns of antifungal susceptibility of dermatophyte isolates and study resistance patterns and cross-resistance among antifungal agents. Materials and Methods: A study was conducted with 60 patients. At visit 1, the patient was started on empiric treatment with terbinafine 250mg daily for 2 weeks. Skin scraping for potassium hydroxide (KOH) mount and fungal culture and antifungal susceptibility testing was collected. After 2 weeks of therapy, the treatment was either continued or changed to a sensitive antifungal agent depending on the susceptibility testing results. The patient was clinically reevaluated every fortnightly. The patient completed a total of 4 weeks of the susceptible antifungal agent. The outcome of therapy was assessed by means of a skin scraping for KOH mount examination. Results: There were 44 males and 16 females. Maximum belonged to the age-group 30–40 years. Maximum patients had tinea corporis (51.6%) followed by tinea cruris (20%). Conclusion: The study provided information regarding clinico-mycological correlation of terbinafine, which revealed terbinafine to be the most effective antifungal agent clinically as well as mycologically.
  2,817 248 -
REVIEW ARTICLE
Cryptococcal meningitis in India
Pushpa Yadav, Manodeep Sen, Anupam Das, Tanushri Chaterji
October-December 2019, 6(4):194-203
DOI:10.4103/mgmj.mgmj_14_20  
Cryptococcal meningitis caused by the environmental yeast Cryptococcus neoformans has emerged as a significant pathogen in immunocompromised and immunocompetent patient especially in human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS). Recent advances in the diagnosis and management of cryptococcal meningitis are promising and have been improving long-term survival. Point-of-care testing has made diagnosing cryptococcal meningitis rapid, practical, and affordable. Cryptococcus neoformans var. neoformans is predominantly found in Cerebro Spinal Fluid sample. Although the diagnostic testing and the antifungal treatment of cryptococcal infections have become firmly established in clinical practice, new developments and the areas of ambiguity merit further consideration. Early diagnosis followed by the institution of specific therapy, where possible, has effectively reduced mortality. This review aims to present status of cryptococcosis in India. Fortunately, new approaches have been leading the way toward improving care for cryptococcal meningitis patients. New trials using different combinations of antifungal therapy are reviewed, and we summarize the efficacy of different regimens.
  2,829 224 -
ORIGINAL ARTICLES
Evaluation of e-learning of undergraduate medical students during the COVID-19 pandemic lockdown by an Objective Structured Practical Examination
Gurjeet Singh, Raksha Singh
October-December 2020, 7(4):176-183
DOI:10.4103/mgmj.mgmj_56_20  
Background: E-learning resources have a broad range of uses in medical education. Skills require the teaching of numerous domains, including cognitive and psychomotor domains in medical education. Feedback supports better competence in medical education, it has been shown that multimedia and e-learning tools have improved testing in both cognitive and psychomotor domains. Aims and Objectives: This study was conducted to evaluate the e-learning of undergraduate medical students with an Objective Structured Practical Examination (OSPE). Materials and Methods: A total of 96 of 150 medical students participated in a single group in e-learning, as this study was purely Internet based, so it may be that the remaining 54 students did not participate due to no Internet connectivity. By using OSPE, we have created two stations (video based), one was hand hygiene and the second was biomedical waste management. At the start of 30min, students were sensitized to lectures (one-way teaching) followed by a 30-min video of each station using the GoToMeeting app. In the end, the students were asked to correct steps of hand hygiene and segregation of biomedical waste, according to the color-coding system. Results: Of 96 students who took both the tests and gave their feedback on the questionnaire, 95.83% felt that they were given adequate time at each station, 68.75% responded that the teaching material provided in the e-learning resources were clear and easy to understand, 73.96% responded that the e-learning resources covered a wider range of knowledge than the traditional examination, 86.46% said that the e-learning resources were helpful in understanding basic hand hygiene concepts, 94.79% said that the e-learning resources were helpful in memorization and revision of hand hygiene practical skills, 61.46% opined that e-learning resources were easier to pass than traditional examination, 96.88% responded that the OSPE assessment of the e-learning process helped in scoring better than the traditional assessment methods and was less stressful, 81.25% said that OSPE helps in e-learning as well as evaluation in competency-based medical education (CBME), and 96.88% said that OSPE should be implemented in medical education as an assessment tool for both formative and summative evaluation. Conclusion: e-Learning advances can possibly substitute face-to-face address in medical education, especially during this pandemic. Such methodologies may not exclusively be vital for successfully handling the clinical training quandary during this present emergency; however, it will likewise serve to establish the framework for educating during future calamities and past.
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Assessment of Correlation between Smartphone Addiction, Social Anxiety, and Self-Esteem: A Cross-Sectional Study
Pandurang Vithal Thatkar, Jeevan P Tonde, Rajesh K Dase, Dattatray D Pawar, Rajavannian Chidambaram
January-March 2021, 8(1):22-28
DOI:10.4103/mgmj.mgmj_81_20  
Background: Research on smartphone and Internet addiction has increased rapidly, indicating its clinical and social significance. This study aimed at exploring the possible relationship between smartphone addiction, self-esteem, and social anxiety. Materials and Methods: A total of 464 young college-going adults participated in this study [male = 175 (37.71%), female = 289 (62.3%)] between the ages of 18 and 28 years old. The study participants were asked to complete a survey having three different questionnaires, namely “Smartphone Addiction Scale,” “Rosenberg’s Self-Esteem Scale,” “and the Interaction Anxiousness Scale.” This study also focuses on gender and age differences regarding smartphone addiction. Karl Pearson’s correlation coefficient and unpaired t-test were used to test the significance of the relationship among study variables. Regression analysis was performed to predict smartphone addiction by using Age, Rosenberg’s Self-Esteem Score, and Interaction Anxiousness Score. Results: The mean smartphone addiction scale (SAS) total score was higher in males as compared with females (P = 0.01). No significant difference was observed in RSE total score and IAS total score among males and females (P > 0.05). Significant correlations were observed among SAS total, RSE total, IAS total, and Age (in years) (P < 0.05). Regression analysis was applied to predict SAS total score by using independent variables such as age, RSE total, and IAS total. The coefficients for age and RSE total score were significant (P < 0.01), and the IAS total was not significant (P > 0.05). Conclusion: Males reported having higher smartphone addiction levels as compared with females. A positive correlation was observed between Social Anxiety and Smartphone addiction. A negative correlation was observed between self-esteem and smartphone addiction, which indicates that the lower the self-esteem, the higher will be the smartphone addiction. Age was negatively correlated with smartphone addiction score and social anxiety score, whereas age was positively correlated with self-esteem.
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REVIEW ARTICLES
Human vaccines industry in China, 2019: Part III
Prasanta Kumar Ghosh
July-September 2020, 7(3):148-154
DOI:10.4103/mgmj.mgmj_51_20  
There are five multinational companies (MNCs), operating in China in the vaccine field. These companies have made a sizable investment in China on various counts, including the establishment of local offices, teaming up with certain Chinese companies, and some have also made a sizable investment in R&D for pursuing both basic types of research as well as application-oriented research and/or manufacturing or repacking facilities. The MNCs sell their proprietary vaccines either directly or have teamed up with Chinese companies for sale.
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ORIGINAL ARTICLES
To compare the efficacy of tamsulosin and tolterodine in double-J stent-related symptoms: A prospective randomized trial
Abhay Mahajan, Dhruti Amlani
October-December 2019, 6(4):175-181
DOI:10.4103/mgmj.mgmj_2_20  
Background: Stent-related symptoms affect nearly 80% of patients with indwelling ureteral stents. Alpha blockers relieve flank pain by blocking alpha-adrenergic receptors and relaxing the smooth muscles of ureter, trigone, and prostatic urethra, thus reducing bladder outlet resistance and voiding pressure, whereas mechanism of anticholinergic drugs involves relief of involuntary bladder contractions that are mediated by muscarinic receptors. We have compared alpha blocker and anticholinergic drugs in reducing stent discomfort. Materials and Methods: The study was conducted from March 2017 to February 2018. A total of 100 patients with unilateral double-J ureteral stenting were randomized, postoperatively into two groups: tamsulosin 0.4mg daily (Group I) and tolterodine 4mg daily (Group II). Results: The mean age was 39.1 years in Group I and 38.0 years in Group II. The male:female ratio in Group I and Group II was 1.38:1 and 1:1, respectively. There was statistically significant difference in urinary symptom score, pain score, and general health score between the two groups in favor of Group I (tamsulosin 0.4mg) at 1week post-stenting and 4 weeks (at stent removal). Conclusion: Oral medication, with uroselective alpha blockers, in patients with indwelling stents reduces stent-related symptoms and negative impact on quality of life.
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Clinical profile and outcomes of patients presenting with acute coronary syndrome in a tertiary care hospital
Vijay K. Kadam
July-September 2019, 6(3):113-117
DOI:10.4103/mgmj.mgmj_7_20  
Objective: This article aimed to study the clinical profile and outcomes of patients presenting with acute coronary syndrome at a tertiary care hospital and to draw conclusions from the above data with regard to characteristics of Indian patients presenting with acute coronary syndrome. Materials and Methods: This cross-sectional study was carried out in one of the teaching medical college hospitals. All patients presenting to casualty with an acute coronary syndrome were admitted to the Coronary Care Unit. Standard history was taken, data were entered into a pro forma sheet, and relevant investigations were performed. Patients with ST-segment elevation myocardial infarction were thrombolysed, taken up for percutaneous transluminal coronary angioplasty (PTCA), or managed conservatively. Prompt medical treatment was started in all cases. The hospital course of the patients including complications, if any, was documented. Results and Conclusion: A total of 100 patients presenting with the acute coronary syndrome were studied. The majority of the patients were found to be male (77%). Hypertension was the most common risk factor followed by smoking, diabetes mellitus, and dyslipidemia. Of all patients, 63% presented with myocardial infarction. Serious complications occurred in 23% patients. The mean age of all patients was 55.5 ± 12.1 years. The age of presentation of females was on average a decade more than that of males. A small but significant percentage (11%) included premature patients younger than 40 years. Most of the patients presented between 1 and 6h of symptom onset. Of all patients, 33% underwent successful PTCA and were discharged on appropriate medication; moreover, 25% were advised PTCA but did not undergo due to various reasons. These were then managed medically. Of all patients, 15% were advised coronary artery bypass grafting and 24% were put on aggressive medical management. A majority of patients presented with single-vessel coronary artery disease (44%) and 3% died during the index hospitalization.
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