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   Table of Contents - Current issue
April-June 2023
Volume 21 | Issue 2
Page Nos. 79-128

Online since Friday, April 7, 2023

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Approach to reducing the burden of pesticide poisoning and improving outcomes in patients with deliberate self-harm p. 79
John Victor Peter, Anitha Paul Mampilly
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Accuracy of ultrasound and magnetic resonance imaging in predicting placenta accreta: A retrospective study p. 83
Premkumar Jaisankar, M Vasantha Kumar, R Rajesh Gowtham, T Vinoth
Background: Placenta accreta can cause significant morbidity and mortality in pregnant women. Timely diagnosis is essential for management. This study aimed to evaluate the accuracy of ultrasound (USG) and magnetic resonance imaging (MRI) techniques in predicting placenta accreta. Methodology: A retrospective study was conducted at our institute from April 2014 to September 2017. Pregnant women with suspected placenta accrete were recruited for the study. Medical records of pregnant women who have undergone both USG and prenatal MRI were included. The accuracy of USG and MRI was compared. Results: Among the 56 cases evaluated in the study, the diagnosis was accurately obtained with ultrasonography in 75% of cases and with MRI in 68.51% of cases. Sensitivity for placenta accreta was 97.29% for USG and 78.37% for MRI. Specificities were 31.57% for USG and 47.05% for MRI. The positive predictive value was 73.46% for USG and 76.31% for MRI. Conclusion: Although a definite demarcation could not be obtained from the sensitivity, specificity, and positive predictive value of the placenta accrete with ultrasonography and MRI, the diagnostic accuracy may be taken as a definite pointer. Hence, ultrasonography remains the mainstay of diagnosis for placenta accrete; and MRI can be considered complementary in cases with few USG signs.
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Morphological variations and biometrics of ear: First documented evidence from ethnic Kashmiri Population (Northern India) p. 88
Shah Sumaya Jan, Sobiya , Bashir Ahmad Shah, Sheikh Mohd Saleem
Background: Anthropometric data for a specific population is always required for identification, product design, ear reconstruction, and manufacture of ear-related instruments. This study aimed to determine the anthropometric measures of the external ear and compare them on both the sides and in either sex among the ethnic Kashmiri population. Methods: The study sample had 98 boys and 102 females aged 18–25. Subjects with a history of craniofacial trauma, ear diseases, congenital defects, or ear surgery were excluded from the study after racial confirmation. A single investigator took all measurements on both the ears using a standard digital Vernier's caliper capable of measuring to the nearest 0.1 mm. Results: It is observed that the total ear width (EW) in the right ear ranged from 2.92 ± 0.19 to 3.12 ± 0.22 in cm. The mean EW on the left ear was found more significant than on the right side in the studied population. The mean TEH among the males in the right ear was found to be 6.02 ± 0.34, while in the left, it was 5.78 ± 0.33. Furthermore, the mean EW among the females on the right side was 2.88 ± 0.21 compared to 2.85 ± 1.25 for the left and right ears respectively. The association was found to be significant (P ≤ 0.001). Conclusion: Identifying landmark variations in distinct ethnic groups could help establish morphological assessment and morphometric variations of human ears.
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Diffusion-weighted imaging in differentiating benign versus malignant lymphadenopathy: A cross-sectional study p. 93
KM Sumith, T Vinoth, P Jenikar, M Vasantha Kumar
Background: Lymphadenopathy requires differentiation into benign and malignant for appropriate management. The current study was done to find out if diffusion-weighted images and apparent diffusion coefficient (ADC) will be able to differentiate benign from malignant cervical lymphadenopathy. Methods: This cross-sectional study was done in the Department of Radiology at Sri Ramachandra Medical College from April 2016 to August 2018. A total of 54 patients with a history of lymphadenopathy were recruited. Histopathological examination (HPE) and magnetic resonance imaging were done for all patients after a complete history and physical examination. The ADC was correlated with HPE in differentiating benign and malignant lymphadenopathy. Results: Majority (46.30%) were in the age group of 51 years and above. Twenty-eight (51.85%) had benign, whereas 26 (48.15%) had malignant lesions. There was a statistically significant difference between the nature of the lesion in ADC value ([× 10–3 mm2/s] [P < 0.001]). The ADC had good predictive validity in predicting malignancy, as indicated by the area under the curve of 0.904 (95% confidence interval 0.821 to 0.987, P < 0.001). Conclusion: ADC values can be used as a complementary tool in assessing the malignant potential of lymph nodes in various conditions and hence play an essential role in the further course of management.
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Predictors of recurrence in oral cavity cancer with clear surgical margins p. 98
Mansi Agrawal, Vidya Konduru, Amit Jiwan Tirkey, Riju Jeyashant, Philip George, Dona Maria Philip, Chandramohan Setty, Kiran Kumar Devarkonda
Introduction: Oral cancers recur in a significant proportion of patients, in spite of aggressive treatment strategies. The presence of a clear surgical margin is an important predictor of recurrent disease, among others. Since oral cancers often recur in the absence of compromised margins, there is a need to study the factors affecting recurrence and overall survival outcomes where clear surgical margins have been achieved during upfront surgery. This study attempts to identify the significant predictors of locoregional recurrence in oral squamous cell carcinoma (OSCC) with pathologically clear surgical margins. Methodology: This retrospective study was done to study the clinicopathological parameters associated with recurrence of oral cavity squamous cell carcinoma (SCC) in patients with clear surgical margins operated in our unit between January 2010 and December 2015. A total of 526 cases of oral cavity SCC were analyzed and records of 160 cases with clear surgical margins were reviewed for clinical details, histopathological data, and follow-up status. Age, gender, subsite, T–N clinical and pathological staging, tumor depth of invasion, grade of differentiation, lymphovascular invasion, perineural spread, adjuvant therapy, and recurrence details were analyzed. Results: Lymphovascular Invasion was found to be a significant predictor for local recurrence in OSCC in both univariate and multivariate analysis. Median recurrence-free survival was 53.6 months. Conclusion: Despite the best efforts of the surgeon in obtaining adequate tumor-free margins and the most comprehensive adjuvant treatment, recurrence patterns in oral cancers continue to defy accurate prediction. Lymphovascular invasion could be an important predictor of recurrence for oral cavity cancers in patients with clear surgical margins that require aggressive management.
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Impact of COVID-19 vaccination on menstruation pattern among female nursing and paramedical students in a peripheral medical college in Eastern India p. 104
Ayan Goswami, Arup Kumar Majhi, Arunima Chaudhuri, Pratip Kundu
Background: Many females worldwide have reported abnormalities in their menstrual patterns post-COVID-19 vaccination. The present study was conducted to determine the impact of the COVID-19 vaccination on menstrual patterns among female nursing and paramedical students at a peripheral medical college in eastern India. Materials and Methods: The cross-sectional, online self-administered survey was conducted using Microsoft Forms after taking institutional ethical clearance and informed consent from the participants. Two hundred BSc nursing and paramedical students who had received two doses of COVID vaccination (Covaxin or Covishield) and were not suffering from any endocrinopathies, bleeding disorders, structural gynecological abnormalities, or taking any medication known to affect the hypothalamic–pituitary–gonadal axis were included in the study. The questionnaire included menstrual length cycle length and amount of bleeding and there were no direct identifiers. Results: The participants reported a significant increase in the amount of bleeding on the heaviest day (mean ± standard deviation [SD] of the number of pads used was 3.52 ± 1.15 during prevaccination months vs. 4.64 ± 1.36 during postvaccination months; P < 0.001) following vaccination. A similar result of increased bleeding on the heaviest day of the period was obtained in both the Covaxin group (mean ± SD: 3.08 ± 1.16 vs. 4.88 ± 1.53; P: 0.001) and the Covishield group (mean ± SD: 3.59 ± 1.13 vs. 4.6 ± 1.34; P < 0.001). No difference in change in the menstrual pattern was observed between the two groups who had received two different types of vaccine (P: 0.527). Conclusion: The study showed a possible connection between the COVID-19 vaccination and the change in menstrual patterns.
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Progression in refractive error in children during COVID-19 pandemic due to virtual classes: A cohort study p. 110
Shovna Dash, Gayatree Mohanty, Soumya Kanta Mohanty, Nirmal Kumar Mohakud
Background: The pandemic resulted in increased screen hours in children due to virtual education. The rate of progression of myopia was noticed to be remarkable in the past 2 years. This study is an endeavor to study the effect of increased screen hours during COVID home confinement on the degree of progression of myopia in school children and to evaluate the difference in change of refractive errors with a variation in the screen size of the digital device used. Methods: This was prospective observational study with a retrospective comparison arm, wherein 70 school children (140 eyes) aged 4–18 years were subjected to a cycloplegic refraction test. The difference in spherical equivalent refraction from the year 2018 to 19 was compared with that of the difference observed in the pandemic year 2019–2020. A statistical analysis was also made regarding the correlation of variation in refraction between the different genders, age groups, and screen sizes. Results: Of the 70 children, 29 (41.42%) were girls and 41 (58.58%) were boys. The gadgets being used vary from mobiles to laptops, and the range of screens and sizes varies from 100 cm2 to 500 cm2. Similarly, the duration of device use varied from 4 to 8 h. For 2018, the mean value of the spherical equivalent was −1.69 ± 1.42, for 2019 it was −1.92 ± 1.50 and for 2020 the mean value was −2.61 ± 1.47 for the right eye. The mean value of the spherical equivalent for the left eye in 2018 was −1.68 ± 1.51, in 2019 the value was −1.87 ± 1.58, and in 2020, the mean value was −2.73 ± 1.78. Conclusions: Increased exposure to digital devices during the COVID-19 period has a role to play in the progression of myopia in school-aged children.
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Clinical, uropathogenic, and radiological profile of culture-positive urinary tract infections in children below 18 months of age p. 114
Sachin George, RV Deepthi, Georgie Mathew, Jude Antony Prakash, Dona Maria, Indira Agarwal
Background: Urinary tract infections (UTIs) are common in children and have the risk of renal scarring. To better identify this at risk group, the following study was carried out to analyze the clinical profile of children below 18 months of age with culture-positive UTI and the outcome of radiological investigations. The primary objective was to assess the clinical profile of culture-positive UTI children and diagnostic yield and correlation between radiological tests. The secondary objectives were to assess the prevalent uropathogens and their antibiogram. Materials and Methods: For this retrospective study, clinical details regarding radiological investigations, prevalent uropathogens and antibiograms, common antibiotics used in treatment, and uroprophylaxis were obtained through electronic medical records in children <18 months of age admitted with culture-positive UTI. Results: In 225 children seen over a period of 36 months, a slight male predominance (56%) was observed. Ultrasonography (USG) was done in nearly all children, micturating cystourethrography (MCU) was performed in only 40% of patients, dimercaptosuccinic acid (DMSA), performed after 6 months of the index UTI, in one-fifths of the patients. All three investigations were performed in one out of six children. USG and MCU used in combination detected the highest number of significant abnormalities (39%) compared to USG and DMSA (32%). Escherichia coli was the predominant uropathogen identified. Significant meropenem resistance (52%) was observed in the community-acquired UTI. Conclusion: The evaluation and follow-up of infants and young children with UTI show inadequate radiological evaluation, which could increase the risk of undetected and untreated renal sequelae.
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A case of transient constrictive pericarditis following COVID-19 infection p. 120
Omar Fakhreddine, Jamil Francis, Joe Younes, Walid Gharzeddine
With the emergence of the novel severe acute respiratory syndrome coronavirus 2 as a global pandemic, the cardiovascular system was considered one of the major systems affected by this virus. Here, we report the case of a 62-year-old male, who was diagnosed with COVID-related pericarditis, presenting with worsening chest pain and shortness of breath, with echocardiographic findings suggestive of early-stage constrictive pericarditis.
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Utilizing the community as a learning resource in the training of undergraduate medical students p. 123
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
The kind and range of attributes that an undergraduate medical student should acquire by the time of completion of their training are extensive. The exposure of undergraduate medical students to the local community during the training period carries immense significance in the learning curve of the students. The exposure to community as a learning resource satisfies multiple principles of adult learning, as medical students can be actively engaged in the learning process, wherein they have to play a specific role and the learning happens across all the learning domains and does not remain restricted to the cognitive domain alone. In conclusion, the use of community as a learning resource for facilitating the training of medical students has been linked with multiple benefits. However, it is quite essential that potential challenges should be identified and accordingly preparation is done by the concerned departments to ensure the attainment of learning objectives and avoid rejection from the community.
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Advocating workplace learning in medical education p. 126
Saurabh RamBihariLal Shrivastava, Rizki Indah Putri Lubis
The journey of a medical student during the undergraduate training period is quite challenging as they are expected to become competent in a wide range of attributes which are essential to a future health-care professional. It is quite obvious that considering the complex nature of attributes that a medical student must acquire, we must expose them to a number of learning opportunities, preferably in their workplace settings. Various learning theories have explained the ways, in which a medical student can learn various skills in workplace settings. However, it is the responsibility of the teacher to optimize the learning experience. Workplace learning in the field of medicine carries immense potential and offers a crucial opportunity for teachers to shape the career of medical students, who will be our future health-care providers. To conclude, workplace learning is an indispensable component of the medical curriculum. As we move forward in our global vision to improve the health indicators and quality of life of the members of the community, we have to strengthen workplace learning across all medical institutions worldwide and this will essentially require the support of all the stakeholders.
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