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   Table of Contents - Current issue
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July-December 2022
Volume 13 | Issue 2
Page Nos. 57-117

Online since Tuesday, January 10, 2023

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ORIGINAL ARTICLES  

Predicting clinical outcome with computed tomography severity score in COVID-19 Highly accessed article p. 57
T Preeth Pany, Nithin Theckumparampil, Aravintho Natarajan
DOI:10.4103/mjmsr.mjmsr_43_22  
Introduction: COVID-19 is a major public health burden in the world, and chest computed tomography (CT) is the ideal imaging modality to diagnose and monitor disease progression. Objectives: The objective was to review the common and uncommon chest CT findings of patients with COVID-19 and to correlate the CT findings with short-term prognosis. Methods: All patients who had laboratory-confirmed COVID-19 infection and underwent CT scan were reviewed. The imaging features and the distribution of abnormality were evaluated. A CT severity score (CT-SS) system out of 40 was used. Mann–Whitney U-test and Chi-square or Fisher's exact test were used for analysis. Two-sided P < 0.05 was considered statistically significant. A receiver operating characteristic curve analysis was performed to calculate the CT-SS cutoff for hospital admission and intensive care unit (ICU) admission. Results: A total of 149 individuals were eligible. The most common imaging features were ground-glass opacities (GGO) (88%), septal thickening (70%), and reticulations (50%). The least common imaging features were pneumothorax (1%) and vascular enlargement (1%). The most common distributions of GGO were bilateral (92%) and multifocal (95%), with peripheral (100%) and lower lobe predominance (77%). A higher CT-SS had a significant association with longer hospital stay and ICU admission, with CT-SS of 18 and 10 being optimal cutoff, respectively. Conclusion: Our study is one of the few studies to correlate the imaging finding with clinical outcomes in the south Indian population. The common findings in our study were consistent with the literature. CT-SS plays an important role in predicting prognosis.
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Comparative study between aspiration followed by Intralesional triamcinolone Injection, mixture of triamcinolone and hyaluronidase and surgical excision for the treatment of forearm ganglion in a medical college hospital Highly accessed article p. 64
Yaqoob Hassan, Ajaz Ahmad Rather, Javid Ahmad Peer
DOI:10.4103/mjmsr.mjmsr_57_22  
Background: Ganglionic cysts are benign tumors of forearm commonly encountered in our day-to-day outdoor practice. This study compares the efficacy, safety, and recurrence rates of triamcinolone, a triamcinolone hyaluronidase mixture, and surgical excision for the treatment of forearm ganglion in a medical college hospital. Materials and Methods: This prospective comparative study was carried out at the SKIMS, Medical College, Hospital, over a period of 3 years. Between January 2018 and January 2021, 96 subjects with forearm ganglion were included and treated in three groups – Group A included patients who had aspiration and injection of triamcinolone; Group B patients had aspiration and injection of mixture of triamcinolone and hyaluronidase; and Group C patients underwent excision under anesthesia. The data were collected and analyzed using SPSS software 22. Results: Among 96 patients who met the inclusion criteria, the mean age was 35.74 years, with a male: female ratio of 0.63. The swelling was the most common clinical presentation recorded in 100% of patients. Swelling with symptoms such as pain and paresthesia was present in 59.38% of the patients, dissatisfaction with cosmetic appearance in 55.21% of the patients, and 36.46% subjects had apprehension of sinister lesion (malignant tumor). 47.92% of patients had aspiration and injection of triamcinolone (Group A), 43.75% of patients had aspiration and injection of triamcinolone-hyaluronidase mixture (Group B), and 8.33% of patients underwent surgical excision (Group C). The difference in recurrence rate was significantly lower in the Group B patients (15.22%) than in the Group A patients (2.38%) (P ≤ 0.05). We observed 100% success rate after surgical excision. No major postprocedure complications occurred in any of the patients. Conclusion: Aspiration and intracystic instillation of a triamcinolone-hyaluronidase mixture is a simple, effective, and safe treatment for ganglion with low recurrence rates. Following an unsuccessful primary therapy of aspiration and injection, surgical excision yielded excellent results.
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Study of hematological changes in patients with chronic renal failure undergoing hemodialysis (pre and post) p. 69
Purna Chandra Das, Soma Ghosh, Uma Banerjee
DOI:10.4103/mjmsr.mjmsr_34_22  
Background: Chronic renal failure (CRF), a debilitating condition responsible for high morbidity and mortality considered a financial burden to the government and society. Determining the prevalence of CRF in any country is important for planning the care of affected patients. Aim and Objectives: The study aimed at looking for the hematological changes before, and following hemodialysis (HD) in CRF patients. The objectives included comparing complete hemogram, coagulation profile, and blood biochemistry before and after HD; determining hematological complications post-HD; taking precautions to reduce morbidity and mortality from hematological point of view; and assessing changes in hematological profile of CRF patients undergoing HD. Materials and Methods: An institutional cross-sectional study was done on 62 patients of CRF undergoing HD. The hematological and biochemical parameters were studied along with urinary findings. Results: Males were more affected in the study. The hematological parameters which were elevated following dialysis were total leukocyte count, erythrocyte sedimentation rate, hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin (MCH), bleeding and clotting time, prothrombin time, activated partial thromboplastin time, but MCH concentration and platelet count showed a fall. Postprandial blood sugar, calcium and erythropoietin showed elevated levels following hemodialysis., while decreased levels were found in fasting blood sugar, sodium, potassium, phosphate, urea, and creatinine. Urinary studies showed a increase in specific gravity and a decrease in 24 h urinary protein. Conclusion: CRF is becoming a dreadful condition in society, with dialysis playing an eminent role in treatment modality. Formulating precautions before and after dialysis based on various hematological and biochemical parameters can help to reduce morbidity and mortality.
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Health-related quality of life of parents of children with beta-thalassemia major attending a tertiary care institution in Eastern India p. 76
Archi Chandra, Sarmila Mallik, Soma Chakrabarti, Nabanita Bhattacharyya
DOI:10.4103/mjmsr.mjmsr_56_22  
Context: Chronic diseases such as beta-thalassemia major among children impact their parents in various ways, as they face continuous stress and strain while striving to provide their children with a best possible care. Literature related to health-related quality of life (HRQoL) among parents of children with beta-thalassemia major are limited among Indian population. Aims: This study aimed to assess the HRQoL of parents of children with beta-thalassemia major attending a tertiary care institution in Eastern India and its various correlates. Settings and Design: This cross-sectional study was conducted at a tertiary care institution in Eastern India. Materials and Methods: A sample size of 192 was selected using the simple random sampling among parents with children suffering from beta-thalassemia major who fulfilled the inclusion criteria. Study participants were interviewed regarding different variables and their HRQoL, using a predesigned, pretested, and semi-structured schedule and the Short Form 36 Health survey, respectively, after obtaining ethical clearance from the Institutional Ethics Committee and informed consent from them. Statistical Analysis Used: Data were entered in MS Excel and analyzed using IBM SPSS 20.0 version (Armonk, NY: IBM Corp). Results: The mean HRQoL score was found to be 38.7 ± 11.3 with an interquartile range of 23–59.7. The Spearman's rho correlation matrix showed that HRQol of parents is weakly positively correlated with the educational status of the father of the child (r = 0.2), educational status of the mother of the child (r = 0.1), family history of thalassemia (r = 0.2), ongoing treatment (r = 0.1), and duration of blood transfusion (r = 0.2). Conclusions: Hence, we can conclude that HRQoL of parents of beta-thalassemia major children was correlated with the educational status of the father and mother, family history of thalassemia, ongoing treatment, and duration of blood transfusion.
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Field test and reporting of disaster waste mapping in flood-affected areas of Kodagu district p. 81
BC Narasimha, Ramachandra Kamath, Sharvanan Eshwar Udayar, Ashwini Madeshan
DOI:10.4103/mjmsr.mjmsr_42_22  
Introduction: Floods are the most commonly occurring hydrological disasters in India. The disaster wastes (DWs) produced in floods involve various departments to clear the waste and consume more resources. Thus, the study was conducted to assess the type and visual quantity of DW during the initial recovery phase in flood-affected areas of the Kodagu district. Materials and Methods: A qualitative study was conducted in randomly selected 10 flood-affected areas in September 2019. Data were collected by a structured questionnaire and analyzed using Epi Info version 7.2. Results: The DWs were present in all 10 areas and it was classified into seven types. Out of 10 flood-affected areas, the majority of the areas had packaging wastes (nine areas) and bedding/furniture/cloth/textile waste (nine areas), followed by rubble/building material (six areas), electrical/electronic waste (five areas), food waste (three areas), and toxic/harmful/hazardous waste and biomedical waste/hospital waste (two areas). The total DW visual quantity was 6220 kg and was highest for rubble/building material DW. Conclusions: The DWs were containing both biomedical and nonbiomedical wastes. The wastes clogged the canals and polluted mainly water and soil. The visual quantity of DW was more and clearing the waste was difficult without the vehicles.
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Sociodemographic factors influencing knowledge, attitude, and practices regarding the prevention of common cancers among adults in urban slum, Kolkata p. 85
Paramita Sarkar, Arnab Sarkar, Rivu Basu
DOI:10.4103/mjmsr.mjmsr_41_22  
Context: Cancer is a serious global public health problem. Public awareness plays a big role in the prevention of cancer. Aims: This study aims to evaluate influence of sociodemographic characteristics and related factors on knowledge, attitude, and practice (KAP) regarding the prevention of common cancers. Settings and Design: This community-based observational, cross-sectional study was conducted in the slum area of urban field practice area of a tertiary care hospital, Kolkata. Materials and Methods: The survey was conducted with a sample of 415 using a semistructured questionnaire related to KAP regarding the prevention of cancers. Mann–Whitney U-test and Kruskal–Wallis test were conducted to determine group differences for sociodemographic variables. Linear correlational analysis was performed to identify associated factors and measure the strength and direction of relationships Results: Median scores for knowledge, attitude, and practice differed by sociodemographic characteristics. Positive correlations were observed between knowledge–attitude (r = 0.395, P < 0.01), attitude–practice (r = 0.391, P < 0.01), and knowledge–practice (r = 0.460, P < 0.01). Age, gender, educational status, and socioeconomic class were significantly associated with KAP score of participants. Conclusions: Knowledge about primary preventive measure was found to be less. The study found varying degrees of positive correlation between KAP. Knowledge and level of education had positive associations with attitude and adherence to preventive measures. The findings suggest a need for targeted community awareness interventions for the elderly populations, among men and those with no school education. The positive linear correlations reaffirm that better knowledge can lead to positive attitude and subsequently in good practices. Extensive health educational campaigns should be provided to the general population.
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Anxiety and depressive symptoms in health-care workers managing COVID-19 patients: A cross-sectional study p. 93
Joel Sabu, K Priya Nayak, Joshua S Chacko, Aiswarya Roy Karintholil
DOI:10.4103/mjmsr.mjmsr_38_22  
Background: Health-care professionals managing the pandemic are at higher risk of developing psychological distress and posttraumatic stress symptoms. The study highlights the importance of evaluating mental health among health-care workers to improve efficiency at work and also proves to be a major step to prevent suicide among health-care workers. Materials and Methods: The authors conducted a cross-sectional questionnaire-based clinical study, using the Depression, Anxiety, and Stress Scale-21 to assess stress, anxiety, and depressive symptoms among doctors and nurses managing COVID-19 patients in Karnataka. Results: Of 233 participants, 3 (1.3%), 27 (11.6%), 15 (6.4%), and 159 (68.2%) participants were suffering from mild, moderate, severe, and extremely severe anxiety respectively; 17 (7.3%), 32 (13.7%), 21 (9%), and 131 (56.2%) are suffering from mild, moderate, severe, extremely severe depressive symptoms, respectively; 15 (6.4%), 19 (8.2%), 26 (11.2%), and 114 (48.9%) are suffering from mild, moderate, severe, and extremely severe stress, respectively. The study also showed that health-care workers who had faced an epidemic in the past were able to cope up with the change in a scenario as compared to those who had not in the past. Conclusion: The study shows the prevalence of stress, anxiety, and depressive symptoms in doctors and nurses. It also shows that people who had exposure to a pandemic in the past were able to cope up better with the situation.
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A cross-sectional study of adverse cutaneous drug reactions with special reference to reaction time p. 98
P Deepthi, Sandhya George, Anita Sanker, Neelakandhan Asokan
DOI:10.4103/mjmsr.mjmsr_49_22  
Background: Adverse cutaneous drug reactions (ACDRs) present with different morphologies and times of onset. Knowledge about the common drugs causing them, their reaction time (time interval between drug intake and the onset of symptoms), and the clinical presentations are helpful in identifying an offending drug, especially in the setting of multiple drug therapies, thereby reducing the morbidity and mortality associated with them. Aims: This study aims to identify causative drugs and clinical patterns of ACDRs in a tertiary care center and to estimate their reaction time. Methods: Sixty-two patients diagnosed to have ACDRs who attended the department of dermatology of a tertiary care teaching hospital during an 18-month period were selected for the study. They were classified into certain, probable, or possible categories as per the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) classification. The frequency of each type of drug reaction, common causative agents, and reaction time of different drug reactions was analyzed. Results: Of the 62 patients, 40 (64.5%) were probable, 18 (29%) possible, and 4 (6.4%) were certain. The most common types of reactions encountered were fixed drug eruption (FDE) (13, 21%), drug hypersensitivity syndrome (12, 19.4%), and maculopapular rash (9, 14.5%). As a single group of drugs, antimicrobials were the most common causative agents (23, 37%) followed by anticonvulsants (16, 25.8%). As an individual drug, phenytoin was the most common causative agent (10, 16.1%), followed by paracetamol (7, 11.3%) and isoniazid (5, 8.1%). Reaction time varied from less than an hour for FDE and urticaria to 3–4 months for exfoliative dermatitis, lichenoid eruption, and folliculitis. Limitations: Small sample size was the major limitation. Conclusion: Reaction time varied from less than 24 h in FDE, urticaria, and angioedema to 3–4 months in exfoliative dermatitis, lichenoid eruption, and folliculitis.
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CASE REPORTS Top

Wegener's granulomatosis mimicking like pulmonary tuberculosis and presenting as cavitating lung disease with mycetoma: A case report with review of literature p. 103
Shital Patil, Deepak Patil
DOI:10.4103/mjmsr.mjmsr_37_22  
Pulmonary tuberculosis (TB) is the most common cause of bilateral pulmonary cavities with constitutional symptoms in India being endemic and more prevalent nature of the disease, irrespective of microscopy or nucleic acid amplification test abnormalities. Pulmonary manifestations of systemic vasculitis have very diverse involvement ranging from nodule, consolidation, and cavitation. In this case report, a 45-year-old female, presented with constitutional symptoms with lung parenchymal consolidations progressed to cavitation, and started empirical anti-TB treatment without mycobacterial microscopic or genome documentation in sputum with clinical or radiological worsening. Bronchoscopy workup is inconclusive and the tropical screen for bacterial, TB, and malignancy was negative and fungal yield Aspergillus colonization. A vasculitis workup was done in the presence of clinical and radiological worsening documented PR3-antineutrophil cytoplasmic antibody positive with very highly raised titers. We have started on steroids and cyclophosphamide with antifungals and clinical response was documented with a near-complete resolution of shadows in 24 weeks.
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Bilateral Poland anomalies with horseshoe kidney: A rare association p. 110
Partha Chakraborty, Priti Majumder, Rahuldeb Mondal, Pankaj Halder
DOI:10.4103/mjmsr.mjmsr_53_22  
Poland syndrome (PS) is a rare congenital disorder characterized by ipsilateral syndactyly and unilateral hypoaplasia of the chest wall. It may also be accompanied by dextrocardia, vertebral deformities, and renal malformations such as undescended testes and pyelonephritis. The degree of intrathoracic visceral compression and chest wall involvement dictate the course of treatment. Surgical drainage is occasionally required to treat sepsis and chronic infection. We present the case of an 11-month-old infant who had bilateral PS, horseshoe kidneys, and right-sided hydronephrosis, which is quite a rare association as per existing literature.
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LETTERS TO EDITOR Top

Normative value of sensory nerve action potential of median and ulnar nerves: A cross-sectional study among healthy adults p. 113
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/mjmsr.mjmsr_54_22  
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Ultrasonography diagnosis of acrania–exencephaly sequence at 22 weeks gestation p. 114
Ravikanth Reddy
DOI:10.4103/mjmsr.mjmsr_65_22  
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COVID-19, casino, brothel, illegal activity, and disease control p. 116
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
DOI:10.4103/mjmsr.mjmsr_51_22  
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Serum B12 and folate level in alcoholics and nonalcoholics: Correspondence p. 117
Pathum Sookaromdee, Viroj Wiwanitkit
DOI:10.4103/mjmsr.mjmsr_60_22  
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