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   Table of Contents - Current issue
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January-June 2019
Volume 10 | Issue 1
Page Nos. 1-41

Online since Wednesday, May 29, 2019

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ORIGINAL ARTICLES  

A comparative study of the quality of sleep in patients in the ward: Pre and postsurgery in a tertiary care hospital in South India Highly accessed article p. 1
SN Prakrithi, Suhas Chandran, M Kishor, TS Pradeep
DOI:10.4103/mjmsr.mjmsr_37_18  
Background: Sleep deprivation has a deleterious effect on recovery in postoperative patients as it can lead to potentially dangerous side effects. The stress of poor sleep along with surgical stress can lead to increased sympathetic activity, which causes increase in catabolic processes, wakefulness, postoperative fatigue, hemodynamic instability, and neurological dysfunction, all of which will adversely affect postoperative recovery of patients. Aims and Objectives: (i) To compare the quality of sleep in patients, pre and postsurgery. (ii) To identify factors causing postoperative sleep disturbance. (iii) To discuss management strategies for improving postoperative sleep quality in surgical patients. Materials and Methods: The study included sixty patients admitted in the general surgical ward, with participants selected by convenience sampling. The Pittsburgh Sleep Quality Index was used to assess pre- and post-operative sleep quality and scores were compared to assess various components of sleep. Comparisons were also drawn with respect to difference in sleep according to age, sex, type of anesthesia administered, history of past use of sleep medications, and room type. Results and Conclusion: Our study showed poor postoperative sleep quality across all subgroups, i.e., age, sex, use of sleep medications, type of anesthesia administered, and room type. During the postoperative period, subjective sleep quality, sleep latency, and sleep disturbance worsened along with reduced duration of sleep, without significant changes in the habitual sleep efficiency and day-time dysfunction. Sleep is an extremely important physiological requirement for recovery after surgical stress. By identifying which component of sleep is being affected more than others, targeted interventions can be designed by the way of pharmacological or non-pharmacological methods to effectively combat sleep disturbance in surgical patients.
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Seroprevalence of IgM and IgG antibodies to toxoplasma infection in human immunodeficiency virus-positive antiretroviral therapy-naive individuals p. 8
Saloni Garg, Babita Sharma, Rameshwari Bithu, Nitya Vyas
DOI:10.4103/mjmsr.mjmsr_6_18  
Introduction: Toxoplasmosis, a zoonotic disease infecting about one-third of the world's population, is caused by intracellular parasite Toxoplasma gondii. It is a major health concern in immunocompromised individuals as in human immunodeficiency virus (HIV)-positive patients. The aim of the study was to determine the seroprevalence of T. gondii infection among HIV-infected antiretroviral therapy-naive individuals attending Integrated Counseling and Testing Center. Materials and Methods: It was a cross-sectional observational study conducted at a tertiary care hospital between April 2015 and March 2016 on 400 HIV-positive patients and 100 HIV-negative healthy adults. Anti-toxoplasma IgM and IgG antibodies were detected using a commercially available enzyme-linked immunosorbent assay kit. Sociodemographic and associated risk factors for T. gondii infection were obtained and the data were analyzed using SPSS version 17.0. Results: Seroprevalence of anti-toxoplasma antibodies among 400 HIV-positive patients and 100 HIV-negative healthy adults was 19.75% and 11%, respectively. Majority of seropositive individuals were in the childbearing age groups. Out of 79 toxoplasma-seropositive cases, 10 were clinically confirmed cases of toxoplasma encephalitis (TE). The mean CD4+ T-lymphocyte count of HIV-positive patients was 255.32 ± 221.19 cells/cmm. Conclusion: The seroprevalence of toxoplasma infection is significantly higher in HIV-positive patients than in HIV-negative healthy individuals. It is important to test all HIV-positive patients for toxoplasma antibodies to prevent life-threatening complication and TE in these patients.
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Satisfaction and preferences of the patient visitors toward visiting hour policy in postnatal ward of a selected hospital, Mangalore: A descriptive study p. 13
Sonia Karen Liz Sequera, Savitha Pramilda Cutinho, Renita Fernandes, Prerna Kathi, Nimmiya Tom
DOI:10.4103/mjmsr.mjmsr_38_18  
Context: Hospital establishes daily visiting hours and rules for the comfort and safety of patients and their loved ones. The need to minimize disruption to the therapeutic environment of the patients while giving patients' and their families' time to be together, is an integral part of patient-centeredness and patient's recovery. Aims: The aim of the study is to determine the level of satisfaction of the patient visitors toward the visiting hour policy, to identify their preferences, and to associate satisfaction toward visiting hour policy with selected demographic variables. Settings and Design: Postnatal ward of selected Medical College Hospital, Mangaluru and a cross-sectional descriptive study design. Materials and Methods: Five-point rating scale to assess the level of satisfaction and a semi-structured questionnaire to identify the preferences of the patient visitors toward visiting hour policy. Statistical Analysis Used: Frequency, mean, standard deviation, mean percentage, and Chi-Square for the association. Results: Majority (74%) were satisfied toward visiting hour policy, and a few (3%) were not satisfied. More than half (59%) visitors prefer the visiting hour policy to be displayed in Kannada language, majority (78%) prefer to have 2-h duration of visiting, and more than half (68%) prefer one visitor at a time. Association was found between satisfaction and experience on previous visits (P = 0.011 < 0.05 level) of the visitors. Conclusions: Pooled results showed that patient visitors were satisfied with visiting hour policy and also had similar preferences for visiting hour policy.
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Functional endoscopic sinus surgery with microdebrider for chronic rhinosinusitis with nasal polyps p. 17
Ju-Song Choe, Kwang-Ho Choe, Nam-Il Ji
DOI:10.4103/mjmsr.mjmsr_44_18  
Objectives: The aim of this study was to compare the effectiveness and safety of functional endoscopic sinus surgery (FESS) with microdebrider for chronic rhinosinusitis with nasal polyps (CRSwNP). Patients and Methods: We evaluated surgical procedures of patients with CRSwNP who underwent FESS between November 2016 and December 2017 with either a microdebrider or forceps. They were randomly assigned to receive either FESS with microdebrider (n = 38) or conventional endoscopic removal (n = 35). Ours is the retrospective study. Results: Seventy-three patients underwent FESS. In the series of microdebrider group, the intraoperative time and blood loss were significantly reduced compared with the one of conventional endoscopic surgeries with forceps or snares. Resection with microdebrider provided more visible surgical field than conventional endoscopic surgery. Conclusion: We found that the effectiveness and safety of FESS with microdebrider for CRSwNP was more advanced than conventional endoscopic surgery.
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Clinical effectiveness of continuous peritoneal lavage in moderately severe to severe acute pancreatitis p. 21
Namhun Jong, Songil Rim, Hyesong Kim
DOI:10.4103/mjmsr.mjmsr_14_18  
Purpose: This study aims to evaluate the clinical effectiveness of continuous peritoneal lavage in moderately severe to severe acute pancreatitis (AP). Materials and Methods: We studied 58 patients with moderately severe to severe AP who were admitted from January 2015 to April 2017. Among these patients, 31 patients were treated only conventional therapy (control group). Twenty-seven patients were received continuous peritoneal lavage with conventional therapy (study group). Laboratory parameters and severity scores were compared before and 7 days after therapy between two groups. Mortality rate, the incidence of local complications and length of hospital stay were also compared between two groups. Results: There were no adverse events (bowel perforation and bleeding) associated with abdominal paracentesis for peritoneal lavage. The level of all parameters (white blood cell [WBC], C reactive protein [CRP], serum amylase, lactate dehydrogenase [LDH], blood glucose, serum creatinine, base excess, and serum calcium) and all the severity scores (systemic inflammatory response syndrome [SIRS], Marshall) were significantly improved 7 days after treatment compared before therapy in two groups (P < 0.05). We also compared the level of all laboratory parameters and severity scores between two groups 7 days after therapy. The level of serum amylase, blood glucose, and serum calcium was similar between two groups 7 days after treatment. In the study group, the level of WBC, CRP, LDH, serum creatinine, base excess, and severity scores (SIRS, Marshall) was significantly improved compared with control group 7 days after therapy (P < 0.05). Mortality rate was significantly decreased in the study group compared with control group (7.4% vs. 16.1%, P < 0.01). The incidence of local complication had also a significant difference between two groups (22.2% vs. 35.5%, P < 0.05). The length of hospital stay was significantly reduced in the study group compared with control group (33.1 ± 28.0 vs. 48.9 ± 36.2 days, P < 0.01). Conclusion: Continuous peritoneal lavage can significantly reduce mortality, complications, and length of hospital stay in moderately severe to severe AP.
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The frequency and patterns of psychotropic use among children and adolescents in an outpatient psychiatric facility: An observational study p. 26
Bilal Ahmad Bhat, Arshad Hussain, Wasim Qadir, Shabir Ahmad Dar
DOI:10.4103/mjmsr.mjmsr_13_19  
Background: Psychiatric disorders are now frequently diagnosed in children and adolescents, and psychotropic medications are being used increasingly for the treatment of these disorders. Aims: The aim is to study the frequency and the pattern of prescription of psychotropic drugs in outpatient child and adolescent psychiatric facility. Settings and Design: This was a cross-sectional descriptive study conducted in outpatient child and adolescent psychiatric facility. Materials and Methods: The outpatient department prescription of all patients who were ≤18 years of age, who attended the Outpatient Child and Adolescent Facility of Department of Psychiatry, Government Medical College, Srinagar, over 1½-year period were studied. The following details were recorded – age, gender, diagnosis with comorbidity, and the psychotropic drugs which were prescribed. Results: A total of 624 patients attended the outpatient service during the study period. The mean age was 7.74 years (standard deviation = 3.76). 67.3% were male. Hyperkinetic disorder (27.1%) and mental retardation (26.3%) were the more frequent diagnosis. Comorbidity was present in 28.8%. 60.6% of the patients were prescribed psychotropic medication with 44.9% being prescribed a single psychotropic, 15.1% were prescribed two psychotropics simultaneously, and 0.6% were prescribed three psychotropics simultaneously. Stimulants (17.5%), risperidone (25.2%), and selective serotonin reuptake inhibitors (9.9%) were the commonly prescribed psychotropics. Statistical Analysis: Descriptive analysis was carried out with Statistical Package for the Social Sciences and results were presented as frequencies and percentages. Conclusion: Simulants, antipsychotics, and antidepressants were commonly prescribed psychotropics with stimulants and antidepressants mostly being prescribed for attention-deficit/hyperactivity disorder and depression, while most of the antipsychotics being prescribed for nonpsychotic conditions.
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SHORT COMMUNICATION Top

Breast cancer prevention and management: Evidence and possibility in India p. 33
Amit Kumar Jain, Parvati Nandy
DOI:10.4103/mjmsr.mjmsr_14_19  
In India, cancer has become a new epidemic, with breast cancer topping the list. Prevention and management of this new epidemic is restrained with limited resources and heterogeneously concentrated cancer care in India. Technology can come to help for the above, and in this short communication below, we shall discuss the prevention and management of breast cancer with special reference to the use of technology for the same in the Indian context.
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CASE REPORTS Top

Infection with Plasmodium falciparum malaria in a patient with homozygous hemoglobin E p. 36
Prasanta Purohit, Pradeep Kumar Mohanty, Jogeswar Panigrahi, Siris Patel
DOI:10.4103/mjmsr.mjmsr_29_18  
We present here a 22-year-old male with hemoglobin E (HbE) infected with severe Plasmodium falciparum malaria. The patient had acute renal failure with moderate anemia and thrombocytopenia. The patient was discharged on the 6th day of hospital admission after clinical recovery. To the best of our knowledge, this is the first report of a case with homozygous HbE and P. falciparum malaria in the state of Odisha, India.
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Intra parotid cystic lymphangioma masquerading as a neoplasm, a rare entity at unusual site p. 39
Nibedita Sahoo, Debahuti Mohapatra, Pranita Mohanty, Prateek Das, Debasmita Das
DOI:10.4103/mjmsr.mjmsr_39_18  
Cystic hygroma is an uncommon congenital malformation and usually present as an asymptomatic, painless, soft, fluctuant mass in infancy, and early childhood. The neck is the most common site followed by the face, tongue, and floor of the mouth. The primary site at parotid gland is extremely unusual, though it can secondarily involves parotid gland. Cystic lesion in parotid brings the other differentials of Warthin tumor, low-grade mucoepidermoid carcinomas, and lymphoepithelial cyst. Fine-needle aspiration cytology is not always diagnostic, and histopathology is the confirmatory. Primary parotid cystic lymphangioma is rare and even rarer in the adult age group. Herein, we report a case of primary parotid cystic hygroma in a 24-year-old male, which was misdiagnosed in cytology and later confirmed by histopathology.
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