Muller Journal of Medical Sciences and Research : Table of Contents

Table of Contents

January-June 2022
Volume 13 | Issue 1
Page Nos. 1-56

Online since Friday, September 2, 2022

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ORIGINAL ARTICLES

	A comparative evaluation of oral clonidine and oral gabapentin as a premedication on postoperative analgesia duration in patients undergoing spinal anesthesia	p. 1
	Rituparna Das, Kallol Paul, Pankaj Kumar Halder, Arpita Choudhury, Sourav Roy, Ambika Debbarma DOI:10.4103/mjmsr.mjmsr_15_22 Background and Objectives: Premedication with oral clonidine or gabapentin reduces the perioperative pain and decreases the requirement of analgesics. Our study aims at comparing the efficacy of oral clonidine and oral gabapentin for postoperative analgesia duration in surgeries done under spinal anesthesia. Materials and Methods: A prospective, double-blinded study was conducted in randomly selected 100 patients undergoing spinal anesthesia for any surgery (excluding cesarean section). Group C received 100 μg oral clonidine and Group G received 600 mg oral gabapentin, 1 h before spinal anesthesia. Blood pressure, heart rate, and Spo2 were recorded at 0, 15, 30, and 60 min interval. Visual analog scale (VAS) was documented for pain assessment at 2, 4, 6, 8, and 24 h from the time of onset of spinal anesthesia. The number of rescue analgesic doses required in 24 h postoperatively was noted. The data regarding the patient's demography, changes in the hemodynamics, VAS score, and requirement of rescue analgesia were analyzed. Results: There was no statistically significant difference in the hemodynamic changes with either group. The mean VAS score in the first postoperative hour was significantly higher for Group C than Group G (P < 0.0001). The mean requirement of rescue analgesic doses per patient was 3.00 ± 0.35 and 1.84 ± 0.58 in Groups C and G, respectively (P < 0.0001). Conclusions: Oral gabapentin is more effective than oral clonidine as a premedication in patients undergoing spinal anesthesia belonging to American Society of Anesthesiologists I and II.
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	Prescribing pattern for acute diarrhea in children: A survey of pediatricians from Maharashtra, India	p. 8
	Vikram S Patra, Jeetendra B Gavhane, Priyanka S Amonkar DOI:10.4103/mjmsr.mjmsr_4_22 Context: Irrational use of medications for acute diarrhea in children is rampant. We conducted this survey to analyze prescription practices among pediatricians for acute diarrhea and their deviation from standard treatment guidelines. Subjects and Methods: A self-administered online questionnaire regarding prescription practices was circulated among pediatricians in Maharashtra, India, through various academic groups on WhatsApp, during the World Oral Rehydration Salt (ORS) Week, 2021. The questionnaire was anonymous and consisted of 15 compulsory close-ended multiple-choice questions. Results: Two hundred and eighty-seven pediatricians participated. Among which, 88.9% of the participants said that they prescribed ORS in acute diarrhea, 26.8% preferred zinc supplementation only in the case of watery diarrhea, 62% used probiotics or probiotics plus zinc combinations, and 60% said that they prescribe antisecretory drugs such as racecadotril. Forty percentage of the participants admitted that they occasionally use antibiotics for the management of acute diarrhea, while 5% said that they frequently do so. Most pediatricians advise appropriate ORS substitutes. Large number of pediatricians perceived probiotics (51.2%), dietary restriction (15.7%), racecadotril (10.5%), and antibiotics (6.3%) to be an important part in managing acute diarrhea. Only 25.4% of the pediatricians answered correctly and said parental counseling along with zinc and ORS work best as treatment. Conclusions: This study demonstrates low adherence by pediatricians to standard treatment guidelines for the management of acute diarrhea. Misuse of antibiotics and unscientific use of drugs were evidenced from this study. Awareness regarding the advantages of ORS among pediatricians is high. At present, there is a need to focus on appropriate feeding practices, emphasizing on the role of zinc and discouraging use of antibiotics, probiotics, antisecretory drugs, and irrational combinations.
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	Cardiac autonomic reactivity to acute ingestion of glucose and fructose in healthy subjects	p. 13
	Savitri Sidddanagoudra, Shantala Herlekar, Ashwini Doyizode, Pooja Hittalamani DOI:10.4103/mjmsr.mjmsr_42_21 Context: Excess intake of fructose in the form of soft drinks and corn syrup is increasing and considered as an interest of community health. The effects on the cardiovascular system due to acute intake of these sugars have not well-studied in humans. Animal studies show a clear relation between ingestion of simple sugar and pathogenesis of hypertension and metabolic disorders. Ingestion of glucose increases cardiac output (CO) without change in blood pressure (BP) and reduces total peripheral resistance (TPR). Fructose increases heart rate (HR), BP, and CO without reduction in TPR. Aims: This study aimed to evaluate the cardiac autonomic reactivity by HR variability (HRV) of basal and after ingestion of water, glucose, and fructose. Settings and Design: Randomized crossover study. Subjects and Methods: The study included 30 healthy both-gender subjects of age 18–24 years. In three separate sessions, HRV responses to one of the three test drinks were measured. (1) plain water, (2) 60 g glucose, and (3) 60 g fructose. Each drink is made up of 500 ml solution by addition of water. Statistical Analysis Used: Analysis was performed by two-way ANOVA. Results: Fructose ingestion showed decreased RR interval (RRI) (696.8 ± 102.7), increased Low frequency power (LF)/High frequency power (HF) (0.94 ± 0.2) compared to glucose (RRI: 747.0 ± 75.1, LF/HF: 0.89 ± 0.3) and water (RRI: 877.1 ± 107.0, LF/HF: 0.84 ± 0.1). Conclusions: Acute consumption of these simple sugars may result in different cardiac autonomic responses, fructose stimulating decreased vagal response.
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	A cross-sectional study of serum B12 and folate level in alcoholics and nonalcoholics	p. 18
	S Myilsamy, Sangeetha Kandasamy, Praveen Vijayakumar, Panneerselvam Periaswamy DOI:10.4103/mjmsr.mjmsr_10_22 Introduction: One of the world's most important public health and global health issues is alcoholism. In terms of illness burden, alcohol is the world's third leading cause of death. Repeated alcohol-related issues in at least two of the eleven life areas that clump together over the same 12-month period are considered as alcoholism (alcohol use disorder). Moderate and heavy drinkers were separated into two groups. Materials and Methods: This is a cross-sectional observational study comprising 25 moderate alcoholics, 25 severe alcoholics, and 50 adult individuals who were nonalcoholics. Data pertaining to demographics, clinical history including alcohol consumption and laboratory data were collected and recorded from the study participants. Laboratory data included parameters like hematological profile, serum Vitamin B12 and folic acid, liver function tests, renal function tests, blood sugar levels, and prothrombin time. Results: In our study, anemia affects 76% of severe alcoholics and 72% of moderate drinkers. Mean Corpuscular Volume (MCV) of more than 99 fl was found in 28% of heavy drinkers and 8% of moderate drinkers. The average Hb in heavy drinkers was 9.372.30. Alcoholics have abnormal red blood cell morphology, such as target cells, acanthocytes, stomatocytes, elliptocytes, and ovalocytes. Discussion: Alcoholism affects both men and women, but it is more common in men, especially in lower socioeconomic groups, in their third to fifth decade. Chronic drinkers are more likely to develop anemia, which is linked to the amount and duration of alcohol consumption. Severe alcoholics are prone to infections. Conclusion: Early detection and treatment of hematological abnormalities associated with alcohol misuse will help prevent future alcohol-related problems and reduce morbidity and mortality.
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	Knowledge on risk factors and warning signs of stroke in Udupi	p. 22
	Maryl Candida Cutinho, Jyothi Chakrabarty, Girish Menon DOI:10.4103/mjmsr.mjmsr_4_20 Background: World Health Organization reports that stroke is the third among the top 10 causes of death in India. Despite this, knowledge among general public about stroke and its risk factors is a bare minimum. The objective of this study was to assess the knowledge on risk factors and warning signs of stroke among selected caregivers and students. Materials and Methods: A descriptive survey was conducted in the medical, neurologic and cardiac outpatient departments of a tertiary care hospital. The participants of the survey were students of the allied health sciences, nursing and engineering, and care givers of patients attending the outpatient departments. The data on the knowledge of risk factors and warning signs of stroke were collected using convenient sampling technique. Results: Twenty-five percentage of the students and 65% of the care givers had only less than average knowledge on warning signs and risk factors of stroke. Conclusions: Knowledge level of the students as well as the care givers is not satisfactory considering the increasing incidence and mortality related to stroke in India. Therefore, training the individuals on identification of signs of stroke and immediate management is vital.
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	Role of “Ferritin” in COVID-19 pneumonia: Sensitive marker of inflammation, predictor of mechanical ventilation, and early marker of post-COVID-lung fibrosis – A prospective, observational, and interventional study in a tertiary care setting in India	p. 28
	Shital Patil, Sham Toshniwal, Abhijit Acharya, Ganesh Narwade DOI:10.4103/mjmsr.mjmsr_19_22 Aims and Objectives: Robust data of ferritin are available as a prognostic marker in bacterial infection and we have analyzed its usefulness in coronavirus disease 2019 (COVID-19) pneumonia in predicting severity of illness, response to treatment, and final outcome. Materials and Methods: A multicentric, prospective, observational, and interventional study included 1000 COVID-19 cases confirmed with reverse transcription–polymerase chain reaction. All cases were assessed with lung involvement documented and categorized on high-resolution computed tomography (CT) thorax, oxygen saturation, inflammatory marker, ferritin at entry point, and follow-up during hospitalization. Age, gender, comorbidity and use of BIPAP (bilevel positive airway pressure)/NIV (non-invasive ventilation) /NIV, and outcome as with or without lung fibrosis as per CT severity were key observations. Statistical analysis was done using Chi-square test. Observations and Analysis: In a study of 1000 COVID-19 pneumonia cases, age (<50 and > 50 years) and gender (male versus female) had a significant association with ferritin (P < 0.00001 and P < 0.010, respectively). CT severity score at entry point with ferritin level had a significant correlation in severity score (P < 0.00001). Ferritin level had a significant association with duration of illness (P < 0.00001). Comorbidities had a significant association with ferritin level (P < 0.00001). Ferritin level had a significant association with oxygen saturation (P < 0.00001). BIPAP/NIV during hospitalization had a significant association with ferritin level (P < 0.00001). Timing of BIPAP/NIV requirement in critical care setting had a significant association with ferritin level (P < 0.00001). Follow-up ferritin titer during hospitalization as compared to entry point normal and abnormal ferritin had a significant association in post-COVID lung fibrosis, respectively (P < 0.00001). Conclusions: Ferritin has documented very crucial role in COVID-19 pneumonia in predicting severity of illness, progression of illness and requirement of mechanical ventilation, assessing response to treatment during hospitalization. Follow up ferritin titre during hospitalization and at discharge can be used as early predictor of post-covid lung fibrosis.
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	Knowledge, attitude, and practice of dental practitioners toward the medicolegal system: A cross-sectional questionnaire study	p. 35
	Ruchika Kallianpur, Treville Pereira, Subraj Shetty, Swati Gotmare, Christina Pereira, AK Anjali DOI:10.4103/mjmsr.mjmsr_17_22 Background: Every element of human involvement is affected by the law, and dentistry is no exception in this respect. The efficient implementation and development of comprehensive care is halted by a lack of awareness of the medicolegal aspects. Awareness of the medicolegal system is as essential as professional competence in the practice of medicine. It only makes it vital for health practitioners to be informed of medical law and ethics because of heightened understanding among patients about the same. Aim: The aim of this study was to evaluate the knowledge and awareness on medicolegal issues among dental practitioners in Mumbai. Materials and Methods: A self-structured, pretested, close-ended, self-administered questionnaire was conducted on 100 dental graduates and postgraduates across Mumbai compromising 11 questions related to the medicolegal system, Consumer Protection Act, and informed consent. Conclusion: Participants were aware of the various aspects of the medical legal system, but lacked comprehension of the finer points. However, they lacked basic information in regard to the medicolegal programs and courses offered in the country.
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	Normative value of sensory nerve action potential of median and ulnar nerves: A cross-sectional study among healthy adults	p. 40
	Sunil Kumar Jena, Manoranjan Acharya DOI:10.4103/mjmsr.mjmsr_14_22 Background: Demographic factors such as age, height, weight, and body mass index are important to affect nerve conduction study. Hence, each neurology laboratory should establish its own normative reference data to evaluate the functional status of peripheral nerves. The aim of this study was to establish the normative value of sensory nerve action potential (SNAP) parameters of median and ulnar nerves. Materials and Methods: This study included 92 healthy adults (52 males and 40 females) between the age group of 20 and 60 years. They were classified into three groups A, B, and C. Body mass index was matched for the selection of study participants. SNAP was recorded as per the standard protocol and room temperature was maintained as per the standard guidelines. Onset latency (OL), amplitude (Amp), and conduction velocity (CV) were recorded for data analysis. One-way ANOVA and post hoc analysis were used for statistical analysis. P < 0.05 was considered to be statistically significant. Results: OL in the older age group was prolonged than younger both in the median and ulnar nerves. CV and Amp were less in the older age group than younger both in the median and ulnar nerves. The increasing tendency of OL was observed after 35 years of age. The decreasing tendency of Amp and CV was observed after 50 years of age. Conclusion: SNAP parameters vary according to demographic region. Hence, each laboratory should establish its own normative data to evaluate the functional status of peripheral nerves.
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	A quasiexperimental study to assess the perception of pain in infants after intramuscular vaccination	p. 44
	Monisha Mathew, Shiny Mathew, Sushma Krishna DOI:10.4103/mjmsr.mjmsr_3_22 Background: Intramuscular (IM) vaccination injections are an important cause of iatrogenic pain. Nonpharmacological intervention helps to reduce pain perception during immunization. Purpose: To compare the pain perception during IM injection, among infants who were breastfed versus local cold application in the vaccination clinic of a tertiary referral center. Materials and Methods: This study was conducted in the immunization clinic of a tertiary center. 60 infants (30 each in the intervention and control group) were selected for the study using simple random sampling method. Demographic proforma, Face, Legs, Activity, Cry, and Consolability (FLACC) pain scale was used to collect data of infants aged of 0–6 months. One group was breastfed and the other group local cold application was applied before the IM vaccine. Infant pain was assessed using the Modified FLACC Pain Scale. Results: Majority of the infants (36.6%) perceived moderate pain when the injection was given after local cold application, whereas least (23.3%) demonstrated moderate pain when the injection was administered after breastfeeding. The median score of infants in the local cold application group (5.5) was greater than that of the breastfeeding group (4.0). Conclusion: The study concluded that the application of cold can be used to reduce pain during IM vaccination in children <6 months of age where breastfeeding is not possible.
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CASE REPORTS


	Diagnostic dilemma in childhood intussusception presenting with encephalopathy	p. 48
	Madhurima Ganguly, Prativa Biswas, Partha Chakraborty, Pankaj Halder DOI:10.4103/mjmsr.mjmsr_6_22 Intussusception is the telescoping of one bowel segment into another. Usually, children below 1 year of age experience this condition and have classical symptoms such as abdominal pain, vomiting, and bleeding per rectum. However, unusual clinical presentations, especially in older children, may deceptively mislead the diagnosis, particularly in the absence of the classical symptoms. We report a case of an 11-year-old male child who presented with seizures, altered sensorium, and nonbilious vomiting. During the emergency surgery, he was diagnosed with an ileoileal intussusception with proximal gut perforation and peritonitis. He had a speedy recovery from neurological symptoms after the surgical intervention.
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	Rat bite in the neonate: A case report and review of literature	p. 51
	Abdullah Shaikh, Pranjali Guhathakurata, Partha Chakraborty, Pankaj Kumar Halder DOI:10.4103/mjmsr.mjmsr_1_22 Animal (dog, cat, and rodent) bite injuries in neonates are common in developing countries, especially when the mother leaves the baby at the side of the field in which she is working. A wide spectrum of rat-bite injuries is described in the literature. Disease following the bite of a rat has been known for many years and has been described as rat-bite fever. We report a case of a 17-day-old female neonate who presented with a severe rat-bite injury to the face, with consequent problems in management.
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SHORT COMMUNICATION


	Role of motivation in accomplishing the learning outcomes among undergraduate medical students	p. 54
	Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava DOI:10.4103/mjmsr.mjmsr_5_22 The branch of medicine is extremely challenging as health-care professionals deal with the lives of humans and the very fact that each patient is different from another. Most of the regulatory bodies governing the delivery of medical education across the globe expect that upon the completion of undergraduate training, a graduate student should attain the core competency to become a lifelong learner. In order to become a lifelong learner, a student has to be a self-directed learner, which essentially requires loads of motivation. The ideal approach will be to carry out aptitude tests before a student joins the medical school and based on the results only enroll them. However, this practice is not being followed in most medical schools across the world. To conclude, acknowledging the complicated and vast nature of the medical curriculum, it is crucial that medical students should be motivated toward their learning. It is the need of the hour that medical teachers and administrators should look for opportunities to motivate the students and provide them with a suitable learning atmosphere that encourages learning.
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