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   Table of Contents - Current issue
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July-December 2018
Volume 9 | Issue 2
Page Nos. 51-121

Online since Tuesday, November 27, 2018

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ORIGINAL ARTICLES  

Safety and efficacy of low-dose transarterial chemoembolization in the hepatocellular carcinoma patients with portal vein tumor thrombosis Highly accessed article p. 51
Won-Gyom Choe, Yong-Gun Jo, Il-Jin Sim, Guk-Song Kim, Guang-Jin Chon, U-Il Song, Yong-Jin Pong
DOI:10.4103/mjmsr.mjmsr_32_18  
Aim: The aim of the study is to analyze the safety and efficacy of low-dose transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT). Materials and Methods: Seventy-five HCC patients with PVTT, who were admitted to our hospital between 2011 and 2015 and underwent TACE, were analyzed. The safety and efficacy of low-dose TACE were evaluated. Results: The objective tumor response rate was 25.3%. The median overall survival time was 10.7 months (95% confidence interval [CI]: 8.2–13.2). The cumulative survival rates at 6, 12, 18, and 24 months were 65.3%, 44%, 17.3%, and 2.6%, respectively. Univariate analysis revealed that alpha-fetoprotein (heart rate [HR] = 1.307, 95% CI: 1.019–1.427,P < 0.05), Child–Pugh classification (HR = 2.984, 95% CI: 1.741–5.115, P < 0.001), PVTT (HR = 3.409, 95% CI: 2.745–4.512, P < 0.001), number of tumor (HR = 2.358, 95% CI: 1.956–3.375, P < 0.001), and size of tumor (HR = 2.301, 95% CI: 1.667–3.268, P < 0.001) were related with survival. In multivariate analysis, Child–Pugh classification (HR = 2.351, 95% CI: 1.256–4.215, P < 0.001), type of PVTT (HR = 2.749, 95% CI: 2.238–3.961, P < 0.001), number of tumor (HR = 1.795, 95% CI: 1.521–3.046, P < 0.001), and size of tumor (HR = 1.917, 95% CI: 1.379–3.057, P = 0.03) were independent predictive factors for survival rates. The incidence of complications due to procedures was 85.3%. Conclusion: The low-dose TACE may be considered selectively to HCC patients with PVTT. Child–Pugh classification, type of PVTT, number of tumor, and size of tumor were checked accurately before operation.
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How should we evaluate the patients with elevated 1 h-plasma glucose? p. 58
Ri-Hyang Paek, Hak-Chol Ri, Chol-Min Pae
DOI:10.4103/mjmsr.mjmsr_25_18  
Objectives: This study evaluated the cutoff values of 1 h-plasma glucose (1 h-PG) for the diagnosis of diabetes mellitus and impaired glucose tolerance (IGT), and demonstrated how to evaluate the patients with elevated 1 h-PG. Subjects and Methods: All patients (n = 1433) without known impaired glucose homeostasis (diabetes mellitus [DM] or prediabetes) that have been submitted to the Hospital of the Pyongyang Medical College Kim Il Sung University were enrolled in this study for evaluation of their glucose homeostasis. Results: The area under the receiver operating characteristic of 1 h-PG during 75 g oral glucose tolerance test for diagnosis of DM and IGT were 0.944 ± 0.020 (95% confidence interval [CI]: 0.906–0.983) and 0.964 ± 0.009 (95% CI: 0.944–0.984), respectively. The most optimal cutoff value of 1 h-PG for DM and IGT were 231.0 mg/dL and 161 mg/dL, respectively About 10.4% of normal glucose tolerance (NGT) subjects diagnosed by the present American Diabetes Association (ADA) criteria had 1 h-PG equal to 161 mg/dL or above, their insulin secretion level of pancreas was as low as IGT patient, insulin resistance was higher than NGT subjects with 1 h-PG <161 mg/dL. Moreover, 29.6% of “IGT” patients diagnosed by the present ADA criteria had 1 h-PG equal to 231 mg/dL or above, their insulin secretion level of pancreas was as low as DM patients, insulin resistance was lower than DM and similar to IGT patients with 1 h-PG <231 mg/dL. Conclusions: The cutoff value of 1 h-PG for DM and IGT is 231 mg/dL and 161 mg/dL, it has high sensitivity and specificity for the diagnosis of DM and IGT. The patients with elevated 1 h-PG should be considered as impaired glucose homeostasis (IGT or DM), and therefore treated in time.
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Thirty-day surgical outcome among patients who had undergone emergency laparotomy in a tertiary care teaching hospital: An audit of 151 cases p. 63
S Chandrashekar, HN Dinesh, S Naveen, MG Lokesh, Ajith Vettuparambil
DOI:10.4103/mjmsr.mjmsr_4_18  
Introduction: Despite being one of the most commonly performed emergency surgical procedures, there is a scarcity of data on the outcomes and postoperative mortality rates of emergency laparotomy. Materials and Methods: A descriptive study was conducted among 151 patients those who underwent emergency laparotomy in the department of general surgery over a period of 8 months. Data were collected from the medical records available in the Medical Records Library. Results: The mean age of the study population was 45 years, with 82.8% being males. The overall mortality rate was 23.84% at 30 days. Conclusion: Emergency laparotomy carries a risk of high mortality and is associated with several modifiable factors. The data presented here reinforce the need for new models of care with increased multidisciplinary input into patient care in the postoperative period.
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Knowledge, attitude, and practice of mothers of under-five children regarding diarrheal illness: A study from coastal Karnataka p. 66
Laxmipati Hanumantagouda Gollar, K Shreedhara Avabratha
DOI:10.4103/mjmsr.mjmsr_55_17  
Background: Diarrhea is the second most common cause of morbidity and mortality among children under 5 years old worldwide. Most of the mortalities and morbidities due to diarrhea can be prevented. Accurate knowledge regarding signs and symptoms, timely and appropriate management at household, and in health services remains an important intervention for reducing mortality and morbidity. The present study was conducted with an objective to determine the knowledge, attitude, and practice of mothers of under-five children regarding the diarrheal illness. Methods: A cross-sectional study was conducted in a Medical College Hospital, Mangaluru. A pretested questionnaire was given to mothers of under-five children when they attended hospital for treatment of their children either as outpatient or inpatient. Results were tabulated and analyzed statistically using frequency, percentage, and Chi-square test. Results: A total of 100 mothers were selected randomly. Majority (40%) of them were in the age group of 21–25 years. All of them were literate with 47% mothers completed high-school education. Majority (40%) of mothers belonged to Class III socioeconomic status. Most of the mothers (84%) had good knowledge regarding signs and symptoms, spread, and prevention. Majority of mothers (77%) had serious attitude toward diarrheal illness. Most of the mothers (76%) practiced good dietary and preventive measures during diarrheal episodes. Rotavirus vaccine was given by 35% mothers to their kids. A strong association is found between age group, educational status, and socioeconomic status and knowledge, attitude, and practices regarding diarrheal illness (P ≤ 0.0001). Conclusion: Maternal education in particular health education should be used as an effective tool to promote knowledge and good practice regarding diarrheal illness in children under 5 years of age. Inclusion of rotavirus vaccine in national immunization schedule will help in improving its coverage.
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Impact of urinary incontinence on quality of life among rural women p. 71
Thilagavathy Ganapathy
DOI:10.4103/mjmsr.mjmsr_10_18  
Background: The exasperating symptoms of urinary incontinence(UI) adversely affect holistic well-being of women. Objective: This cross-sectional study aimed to evaluate the impact of symptoms of urinary incontinence on the health-related quality of life (HRQOL), using King's Quality of Life Health Questionnaire among women in India. Methods: A total of n = 611 women were screened for stress, urgency, and mixed urinary incontinence by purposive sampling method at Gottigere, Primary Health Center Bangalore South, Karnataka, India. Results: The prevalence of urinary incontinence (UI) was (23.08%) with majority presenting stress (54.61%) followed by urgent (27.66%) and mixed (17.73%) incontinence. The overall HRQOL in role limitations, daily activities, general health, physical/social well-being, sleep/energy, emotions, and personal relationships domains was poor with insignificant difference among stress versus urgency versus mixed incontinence (P = 0.641). The symptoms of UI such as frequency, nocturia, nocturnal enuresis, urgency, and stress, leakage during sexual relationships, infections, and pain had a negative impact on their QOL. Advancing age, parity, history of instrumental delivery, chronic cough, and constipation were found to be the most influencing factors for the episodes of UI and poor QOL among women. Conclusion: The detrimental consequences of urinary incontinence on the HRQOL of women need a paradigmatic shift in treatment approach.
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Study of the early perinatal outcomes in babies born to young and older mothers p. 78
Swathi Shenoy, Pavan Hegde, Habeeb Ullah Khan, MD Jaidev
DOI:10.4103/mjmsr.mjmsr_64_17  
Background: Pregnancy at young age has been recognized as one of the most important social and public health issues all over the world. Studies done have shown that these are the adverse outcomes and complications linked to pregnancy at a young age such as the need for instrumental delivery or cesarean section, postpartum hemorrhage, prematurity, low birth weight, low APGAR score, Neonatal Intensive Care Unit (NICU) admissions, and perinatal mortality are significant. The aim of our study was to know the neonatal outcomes (birth weight, APGAR score, and NICU admissions) in young mothers and older mothers and to compare the neonatal outcomes of these two groups. Materials and Methods: Our study was a retrospective chart-based study, done in neonates delivered to young mothers (19–21 years) and older mothers (22–30 years). Parameters included in our study were period of gestation, birth weight, APGAR at 1 min and 5 min, NICU admissions, and neonatal outcomes such as asphyxia, hypoglycemia, jaundice, convulsion, and sepsis. Data were recorded in a pro forma. Collected data were analyzed using frequency, percentage, Chi-square test, and odds ratio. Results: A total of 330 neonates were included in the study (165 cases and 165 controls). In young mothers, there was higher incidence of preterm deliveries, 60 cases as compared to 9 controls were of gestational age 28–34 weeks, 60 cases had low birth weight as compared to 21 babies in the control group, and 90 babies born to young mother's required NICU admissions as compared to 23 babies born to older mothers. Neonates born to younger mothers had a higher incidence of NICU admissions, hypoglycemia, sepsis, and neonatal hyperbilirubinemia as compared to older mothers, whereas the incidence of APGAR at 1 min and 5 min showed no correlation between both the groups. Conclusion: Young mothers had a higher incidence of having preterm babies, low birth weight babies, with comorbidities and NICU admissions as compared to older mothers.
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Attitude towards women empowerment among husbands of eligible couples in a rural area of Hooghly district, West Bengal p. 81
Nazrul Mallick, Bijit Biswas, Aparajita Dasgupta, Bobby Paul, Shobhit Garg
DOI:10.4103/mjmsr.mjmsr_11_18  
Background: Empowerment is an important determinant of women's health. The most important social factor of women empowerment is her partner's perception toward it. The attitude of men toward women empowerment is one of the major public health and human rights issues in the world today. With this background, the current study was designed to explore the attitude toward women empowerment among husbands of eligible couples. Materials and Methods: It was a community-based observational study, cross-sectional in design conducted from March to June 2016, carried out in a rural area of Hooghly district, West Bengal among 125 husbands of eligible couples. Data were analyzed using IBM statistical package for social sciences, SPSS statistical software program (version 16) by appropriate statistical methods. Results: Among husbands of eligible couples, favorable attitude toward women empowerment was found to be 20%. In univariate logistic regression, husbands age (odds ratio, (OR)-2.9 [1.1–7.4]), educational status (OR-3.2 [1.1–9.4]), wives age (OR-2.9 [1.1–7.4]), type of family (OR-3.3 [1.1–9.4]), and religion (OR-7.3 [2.8–19.1]) were significant predictors of husbands attitude toward women empowerment. In the final multivariable logistic regression model, husband education (adjusted OR, AOR-3.3 [1.1–9.6]) and religion (AOR-4.7 [1.5–14.5]) were significant predictors of husbands attitude toward women empowerment adjusted with husbands age with (predictive accuracy rate) PAR of 81.6%. Conclusion: Favorable attitude toward women empowerment was quite low. Husbands educational status and religion were some key predictors of women empowerment. Awareness generation campaigns with the involvement of religious leaders to improve attitude toward women empowerment, especially in reluctant religious pockets, should be organized.
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A study on role of chest X-rays in children above 5 years admitted with asthma exacerbation p. 87
Sujonitha John, MD Jaidev, Habeeb Ullah Khan, Pavan Hegde
DOI:10.4103/mjmsr.mjmsr_16_18  
Context: Asthma is a heterogeneous disease characterized by chronic airway inflammation that causes airway hyperresponsiveness. The diagnosis of asthma is mainly clinical, and chest X-rays are not required for the diagnosis or grading of severity of disease. Aim: The aim of this study is to look at the frequency of abnormalities and the pattern of abnormalities in chest X-rays done in children above 5 years admitted with acute asthma and to analyze if chest X-ray reports altered the ongoing treatment plan. Settings and Design: It was a retrospective study done in a tertiary care hospital. Methods: Data were collected from case records of children above 5 years admitted with acute asthma between November 2014 and October 2017. Statistical Analysis: The statistical analysis was done using Chi-square and Fisher's exact test. Results: A total of 114 children were included in the study, and 84 (74%) had chest X-rays performed of which 88% were normal. Nineteen (22.6%) complied with standard guidelines, and the reason for performing chest X-rays in these children was the presence of focal clinical chest signs. When there were focal clinical findings, the possibility that chest X-ray would be abnormal was 47.37%. When there were no focal clinical findings, the possibility that chest X-ray would be normal was 98.46%. The sensitivity of chest X-rays with clinical correlation was 90% and specificity was 86.48%. Hence, routine chest X-rays in the standard treatment of acute asthma are not necessary, especially when there are no focal clinical findings. Conclusion: Chest X-ray is not required in the management of acute asthma in children above 5 years responding to standard treatment. Chest X-rays should be ordered in the management of acute asthma only when indicated, thereby reducing unnecessary exposure to radiation.
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Pap smear awareness, utilization, and pattern of cervical intraepithelial neoplasia among women attending a tertiary hospital in Northwestern Nigeria p. 90
Abdulrahman Shuaibu, Bukar Alhaji Grema, Godpower Chinedu Michael
DOI:10.4103/mjmsr.mjmsr_34_18  
Background: Globally, cervical cancer affects approximately 528,000 women each year, with about 80% of them occurring in developing countries. Developed countries have successfully reduced the incidence of cervical cancer by 70% through organized cervical screening programs. Objective: The aim of the study is to assess the level of Pap smear awareness and utilization among adult females attending the general outpatient clinic of Aminu Kano Teaching Hospital, Northwestern Nigeria, in order to encourage early detection of premalignant cervical cancer. Methods: This was a descriptive cross-sectional study that assessed Pap smear awareness, utilization, and pattern of cervical intraepithelial neoplasia among 422 adult females in Kano, Northwestern Nigeria, using an interviewer-administered questionnaire. SPSS version 20 was used to analyze the data. The sociodemographic characteristics of participants, risk factors of cervical cancer, and awareness and utilization of Pap smears by participants were expressed in means and proportions. The Chi-square test was used to explore associations between categorical variables. Logistic regression was performed to identify the predictors of Pap smear awareness and its utilization among the study participants. P < 0.05 was considered statistically significant. Results: Of the 422 women who participated in the study, the majority (292, 69.2%) had never heard of Pap smear screening while 130 (30.8%) were aware of Pap smear. Similarly, 342 (81.0%) women who participated in the study had never undergone a Pap smear. Three hundred and eight (74%) had normal cytology results, 107 (25%) had inflammatory changes, 4 (0.8%) had low-grade squamous intraepithelial lesion, and 1 (0.2%) had high-grade squamous intraepithelial lesion. Having higher education and being employed were associated with Pap smear awareness while increasing age and educational level were associated with Pap smear utilization. Conclusion: This study revealed a low awareness and utilization of Pap smear screening in Northwestern Nigeria.
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SHORT COMMUNICATIONS Top

Implementing case-based learning in medical colleges in India p. 98
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_18_18  
In the current era, it is a great challenge for the teachers to identify effective ways to aid undergraduate medical students to accomplish the learning outcomes successfully. In order to achieve this as well as assist an Indian Medical Graduate to acquire five basic roles, the use of case-based learning (CBL) is an effective approach, as it not only imparts subject content but also engages the students in real-life case scenarios. Further, CBL should be considered as a supplementary tool in our conventional teaching; otherwise, it will not deliver the desired outcomes. To conclude, CBL is an effective method of teaching–learning and the prospects of incorporating the same within the curriculum to make the learning more simplified and authentic should be explored by medical colleges in India.
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Feedback – Time for learner-centric approach p. 100
Divya Goel, Sanjay Gupta
DOI:10.4103/mjmsr.mjmsr_35_18  
Feedback has been recognized as pillar for effective clinical training. Feedback is a complex, bidirectional process between educator and learner which is influenced by a number of factors. Recently, there is shift from an educator-centric approach to a learner-centric approach that aims to understand how learners seek, receive, and incorporate feedback in their learning process. The objective of this paper is to understand various factors which influence the learner role in learner-centric approach.
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CASE REPORTS Top

Giant bowen's disease in a paddy field worker p. 103
Divya Nair, Betsy Ambooken, Neelakandan Asokan
DOI:10.4103/mjmsr.mjmsr_30_18  
Bowen's disease (BD) is a squamous cell carcinoma (SCC) in situ with the potential for significant lateral spread. Progression to invasive SCC is rare. A 64-year-old female paddy field worker presented with a giant-sized BD on the back of the trunk. Traditional clothing (short blouse with dhoti) which exposed the back of the trunk to long hours of sunlight might explain the location of the lesion. In spite of extensive lateral spread, there were no features to suggest deeper invasion.
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Enigmatic picture of Salmonella bacteremia with mycotic aneurysm and hepatitis p. 105
NS Harsha, BM Suraj, Supreeth S Kanakavidu, Ramyasri Kodali
DOI:10.4103/mjmsr.mjmsr_8_18  
Salmonella bacteremia commonly presents as typhoid (enteric) fever in tropics. Seldom do we come across some of extraintestinal manifestations of salmonellosis such as mycotic aneurysm and hepatitis. We are submitting the case details of a 60-year-old male who presented with compressive features of a ruptured mycotic aneurysm and hepatitis. Ruptured mycotic aneurysm was accidentally discovered during imaging study of the spine. Such cases pose a diagnostic challenge and require meticulous search for cause.
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LETTERS TO EDITOR Top

Reducing the deaths of under-five children through integrated community case management strategy in Nigeria p. 108
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_3_18  
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Resorting to programmatic assessment in medical education system in India p. 110
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_21_18  
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Offering customized and supportive care to ensure positive childbirth experience: World health organization p. 112
Saurabh RambihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_12_18  
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Brainstorming: A tool to facilitate learning among undergraduate medical students p. 114
Saurabh Rambiharilal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_19_18  
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Containment of noncommunicable diseases to accomplish universal health coverage p. 116
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_22_18  
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Improving the living standards and health status of the migrant women workers p. 118
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_5_18  
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Reduce burden of questionable publication from Indian authors: Young academicians' perspective p. 120
Shaikat Mondal, Himel Mondal
DOI:10.4103/mjmsr.mjmsr_33_18  
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