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   Table of Contents - Current issue
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July-December 2019
Volume 10 | Issue 2
Page Nos. 43-93

Online since Friday, January 24, 2020

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ORIGINAL ARTICLES  

A clinical study on the application of diabetic neuropathy index for the diagnosis and staging of diabetic peripheral neuropathy Highly accessed article p. 43
O Kwang-Chun, Ran-Hui Kang
DOI:10.4103/mjmsr.mjmsr_8_19  
Context: There are many methods for the diagnosis and staging of diabetic peripheral neuropathy (DPN), but they are usually complicated and comparatively expensive. Aims: The aim of the study is to establish the new methods based on diabetic neuropathy index (DNI) for the diagnosis and staging of DPN and to demonstrate its scientific validity in terms of DPN. Settings and Design: We used the neuropathy symptom score and the neuropathy examination score as standard criteria in our study. The sensitivity and specificity of the diagnostic methods using DNI were compared with standard criteria. Subjects and Methods: The DNI questionnaire asked about the medical history of diabetes, symptoms, peripheral neuropathy-related symptoms, characteristics of neuropathy, and findings associated with differential diseases. These parameters were assessed at positive or negative. We also evaluated some parameters associated with neurological examination, electromyography, and diabetic complications. Statistical Analysis Used: t-test was used to compare the characteristics between different treatments, and the receiver operating characteristic (ROC) curve was used to set the cutoff points. Results: The significant parameters for DPN diagnosis were DPN symptoms, tuning fork, Achilles reflex, tactile sensation, duration of diabetes, and reduced visual power. The area under the curve of DNI at ROC was 0.999, which means ROC was significant statistically. The best cutoff point to diagnose DPN was 4 in case of using DNI. Conclusions: Our study suggests that the DNI method is a relatively easier and cost-effective approach in terms of DPN diagnosis and staging because it has high sensitivity and specificity.
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Exploring the anti-allergic property of potentized sodium chloride using nasal eosinophil count as a criterion p. 47
Dania P Johnson, K John Paul
DOI:10.4103/mjmsr.mjmsr_21_19  
Background: Nasal eosinophilia is a specific and valuable means for diagnosing and predicting the prognosis of allergic rhinitis (AR). Evidence-based recommendation for treating AR with homeopathic medicines is lacking. Symptomatology of Natrum Muriaticum (NM) derived from homeopathic pathogenetic trials and clinical proving aids its wide use in practice. Objective: The study aided in ascertaining the anti-allergic property of NM in lowering the nasal eosinophil count in patients with AR. Methods: This prospective, observational study included patients diagnosed with AR along with nasal eosinophilia, provided they received NM 30C homeopathic remedy. Written consent was obtained from 15 patients and then included in the study. Nasal smear was collected on the first visit before the treatment and at the end of 2 weeks after the treatment. Statistical Analysis and Results: Pre- and post-treatment nasal eosinophil counts were statistically analyzed using the paired t-test. The difference in mean eosinophil count (0.06333) was statistically significant, where P < 0.00000085. Results: From the study conducted, the eosinophil count was recorded before and after treatment [Figure 1]. Out of 15 participants, two had moderate eosinophilia and 13 had mild eosinophilia before treatment. There was no eosinophilia in any of the patients in the 2nd week after NM intake. Conclusions: It was evident that NM lowers the nasal eosinophil count when administered according to homeopathic principles. Nevertheless, it has opened new avenues to investigate the underlying mechanisms of the anti-allergic property possessed by NM through in vitro studies.
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Distribution of AO13-C fractures and results of double plating using triceps V-shaped transection versus olecranon osteotomy approach p. 51
Tae-Song So, O Chang-Hwan, Gyong-Il Kim, Hyon-Ho Pak
DOI:10.4103/mjmsr.mjmsr_5_19  
Purpose: The purpose of this study is to investigate the distribution of AO13-C fracture and evaluate the surgical results of olecranon osteotomy approach and triceps V-shaped transection approach. Materials and Methods: Retrospective analysis of 86 patients with intraarticular fracture of distal humerus treated with double plating through olecranon osteotomy or triceps V-shaped transection approach between January 2007 and May 2015 was conducted. Distribution in relation to age, gender, side, injury mechanism, concomitant injury, fracture type, and soft-tissue injury was investigated and evaluation of surgical results was performed. Results: Most patients were female, totaling 60 (69.77%). Of 60 female patients, ones aged 40–49 years were 26 (approximately 43.3%). Regardless of gender, most cases, 64 (74.4%) in all, occured on the left arm. Injury mechanisms of fifty cases (58.1%) were simple fall. In 18 cases occured by fall from height ipsilateral distal radial fracture were revealed, totalling 6 (33.3%). According to AO classificaiton, 74 (86%) cases were AO13-C2. At the time of the latest follow-up, flexion arc was 118° ± 1.1° in the triceps transection whereas 100° ± 1.1° in the olecranon osteotomy (P < 0.05). Conclusion: AO13-C fractures were occurred most commonly in the middle-aged women of forties, mainly on the left arm, by simple fall, with the similar configuration to AO13-C2.2 or Riseborough and Radin type II. In the fall from height ipsilateral distal radial fracture must be examined closely. Final functional range of motion, interestingly, was better in triceps V-shaped transection than olecranon osteotomy, implying the importance of postoperative physical therapy and relatively good prognosis of elbow injury in general.
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Guillain–Barre syndrome in pregnancy and its association with maternal and perinatal outcome p. 58
V Rupalakshmi, Shraddha K Shetty
DOI:10.4103/mjmsr.mjmsr_32_19  
Background: Guillain–Barre syndrome or acute inflammatory demyelinating proliferative syndrome is rare in pregnancy. It affects the nervous system, presenting as an acute onset of symmetric ascending weakness resulting in respiratory failure and autonomic dysfunction. Aims: This study aims to study the incidence of GBS in pregnant women and its association with maternal and perinatal outcome. Settings and Design: Retrospective observational study conducted at a tertiary care hospital. Materials and Methods: Records of all women diagnosed as GBS in pregnancy and postpartum period were analyzed. Maternal and perinatal outcomes were studied based on the pattern of involvement of limbs, need for ventilator support, treatment with plasmapheresis and intravenous immunoglobulin (IVIG), intrauterine fetal demise (IUFD), and neonatal deaths. Results: During the study of 3 years, there were 11,484 deliveries, of which 8 women had GBS. The incidence of GBS was 0.06%. Lower limb weakness developed in 6 (75%) of women, bifacial weakness in 2 (25%), IVIG received by 3 (37.5%), and (62.5%) underwent plasmapheresis. Four (50%) required ventilator support and maternal mortality was recorded in 2 (25%) due to respiratory failure and IUFD in 2 (25%) of women. Conclusions: GBS is associated with high maternal and perinatal morbidity. Timely diagnosis by obstetricians and management in women complaining of muscular weakness and respiratory difficulty in pregnancy and early postpartum period will help in improving the maternal and perinatal outcome.
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The acceptance and practice of exclusive breastfeeding by female health professionals: Our experience in a tertiary health facility p. 62
Ibrahim Aliyu, Taslim O Lawal, Halima Umar Ibrahim, Zainab F Ibrahim
DOI:10.4103/mjmsr.mjmsr_1_19  
Introduction: Exclusive breastfeeding (EBF) is the feeding of infants with breast milk alone in the first 6 months of life. EBF is an important component of the child survival strategy and the Baby-Friendly Initiative. Exclusively breastfed babies are often at lower risk of diarrhea disease and respiratory tract infection, and they have a better growth pattern. Over the years, there has been a progressive decline in the acceptance of EBF by breastfeeding mothers; this study, therefore, sought to determine the acceptance of EBF among health workers. Materials and Methods: This was cross-sectional and descriptive study involving female health workers who had children while working with Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria; it was conducted between October 2017 and December 2017. Female health workers comprising doctors, nurses, pharmacists, and laboratory scientists/technicians were recruited. Pretested, structured, and self-administered questionnaires were used. Results: One hundred and twenty-three respondents were recruited for this study, and 95.1% of the respondents were aware of EBF. Among those who were aware of EBF, 61 (52.1%) correctly defined it and 82 (70.1%) practiced EBF, while among non-EBF mothers, the most common reason for not practicing EBF was the demands of their work; however, only 3 (7.3%) had good knowledge of EBF. Majority of the respondents from the clinical departments practiced EBF, and this observation was statistically significant (χ2 = 11.382, df = 4, P = 0.021). Most of the respondents from the surgery and obstetrics and gynaecology (O and G) departments could not correctly define EBF; this observation was also statistically significant (χ2 = 11.642, df = 4, P = 0.019). Conclusion: Most of the respondents in this study were aware and also practiced EBF; however, their knowledge base of EBF was dismally poor, especially those in the surgery and O and G departments .
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Stress and burden among parents of students in special schools of Mangaluru: A cross-sectional study p. 66
Laimayum Nivedita Devi, Mackwin Kenwood D'Mello, Priyanka Dsouza Rent
DOI:10.4103/mjmsr.mjmsr_24_19  
Background: About 15% of the world's population lives with some form of disability; 2%–4% experience significant difficulties in functioning. Parents who are the primary caregivers of a child with a disability face numerous challenges in day-to-day life, which, in turn, affects their psychological health. Objectives: This study was conducted to determine the level of stress and burden among parents of a child with a disability, to identify the coping strategies used by the parents, and to assess the effect of sociodemographic variables on their level of stress and burden. Materials and Methods: This cross-sectional study was conducted in three special schools of Mangaluru taluk; a total of 112 parents whose children were enrolled in these special schools participated. Family Stress and Coping Interview and Zarit Burden Interview scale and a modified questionnaire on coping strategies were used to calculate the stress and burden level. Results: Nearly 47.33% of the parents reported mild-to-moderate stress, whereas 25% of the parents reported high stress, 50.9% of the parents reported mild-to-moderate burden, and 26.8% accounted for moderate-to-severe burden. There was a significant association between the level of stress, level of caregiver burden, and sociodemographic variables such as residents, occupation, education, and rehabilitation services. There is moderate and strong evidence of a positive correlation between the caregiver burden with the age of the child (r = 0.245, P = 0.009) and stress (r = 0.45, P < 0.001). The parents of children with disability undergo stressful events throughout their life; the sociodemographic factors have significant association on the level of stress and burden. Conclusion: The various program measures such as adult day care, improvised home-care, and use of assistive equipment can be undertaken to reduce caregiver burden.
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The mathematical model to select an optimal treatment option for tubal pregnancy p. 73
Jin Jong Hwa, Kim Suk Yong, Paek Un Son
DOI:10.4103/mjmsr.mjmsr_42_18  
Background: Tubal pregnancy is one of the most common diseases in the gynecological department, and to conserve the reproductive ability and guarantee the quality of life, it is very important to select the prompt and correct treatment options. We studied to formulate the mathematical model to select optimal treatment option of tubal pregnancy and evaluate its effectiveness. Materials and Methods: Chi-square test and the analysis of quantization category II were used for the comparison of parameters between two groups. We underwent case–control study of 59 patients with medical treatment and 44 patients with surgical treatment in Pyongyang Maternity Hospital from October 2013 to February 2015. Results: We analyzed the anamnestic, subjective symptom, objective symptom parameters, compared the correlation coefficients, and defined 15 parameters. Conclusion: We assessed the appearance of parameters to select the treatment option of tubal pregnancy, and the sensitivity, specificity, and predictive value of the mathematical model were 93.2%, 90.9%, and 0.932, respectively.
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SHORT COMMUNICATIONS Top

Urgent need of one health approach to contain antimicrobial resistance p. 78
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_30_19  
The emergence of antimicrobial resistance has been regarded as a global public health concern and is expected to play an important role in the accomplishment of Sustainable Development Goals. It is quite alarming that resistance has been reported across the globe and we are reaching that stage in which common infections will become intractable. Acknowledging all these aspects, it is quite certain that we all don't have much time and there is an immense need to formulate a plan, implement holistic strategies and supplement the same with adequate financial support to minimize the impact on the future generations. It is quite obvious that these measures cannot be sustainable unless there is a strong political leadership and cooperation from all the sectors. In conclusion, antimicrobial resistance is a global concern and is a complex challenge to deal with. Thus, it is the need of the hour to formulate a One Health response to benefit the current and future generations of people.
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Envisioning creation of a healthy city: The need, existing challenges, and potential actions p. 80
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_34_19  
In an attempt to improve the living standards, millions of individuals have migrated to cities and the current estimates reveal that 50% of the global population are living in cities. However, the life in a city poses a wide gamut of challenges and it is important to understand that health standards are not only determined by access to health system but also by supporting infrastructure and facilities. All these facts emphasize the need to create such kind of cities that can shield and promote health through the implementation of appropriate policies, structural reforms, and launch of health programs. The creation of a healthy city requires some key issues to be addressed, including mental illness, physical inactivity, consumption of unhealthy diet, pollution and environmental health hazards, road traffic injuries, and urban violence. In conclusion, the creation of a healthy city should be looked upon as an opportunity to not only improve the well-being of the general population but also will aid in the accomplishments of universal health coverage, national, and global goals for development.
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CASE REPORTS Top

Hypohidrotic ectodermal dysplasia with autosomal inheritance: A rare entity p. 82
Ayushi Lodha, Shylaja Someshwar
DOI:10.4103/mjmsr.mjmsr_41_19  
Hypohidrotic ectodermal dysplasia (HED) is a rare disorder which is characterized by the involvement of all ectodermal derivatives and marked deficiency of sweating. It has a prevalence of 1: 100,000. X-linked recessive fashion is the most common pattern of inheritance, and 90% of the individuals affected are males. Autosomal dominant and recessive forms of this disease are very rare. Here, a 24-year-old female presented with classical features of HED: sparse lusterless hair, everted lips, and artificial dentures with a history of hypodontia in childhood. Patient's niece had complaints of decreased hair growth and sweating since birth. The patient also gave a history of similar complaints in great grandmother. Hence, we present an uncommon scenario where three females of an extended family were affected with HED and had symptoms of varying severity.
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Dilated cardiomyopathy following H1N1 infection p. 86
Sweta Shanbhag, Rashmi Alva, K Shreedhara Avabratha
DOI:10.4103/mjmsr.mjmsr_40_19  
Acute myocarditis and dilated cardiomyopathy are known to be common manifestations of several viral infections, presenting with a wide spectrum of symptoms. The exact pathogenesis of influenza virus-induced myocarditis is still unclear. Management involves early detection using echocardiography and cardiac support to tide over acute phase. Following recovery, prognosis is known to be quite good; however, fulminant cases have poor prognosis. A 2-year-old female infant previously diagnosed to have H1N1 bronchopneumonia a year back, who was found to have compromised cardiac function suggestive of dilated cardiomyopathy on follow-up and was started on oral antifailure medications and kept on regular follow-up, presented to the emergency department with symptoms suggestive of severe form of dilated cardiomyopathy and succumbed to illness. The association between influenza viral infection and myocarditis is being linked with host immune response as well as direct cellular damage. Vaccination is being said to be the most cost-effective strategy to prevent this potentially fatal complication. Recent-onset cardiac symptomatology with a preceding history suggestive of influenza infection warrants a high index of suspicion for myocarditis and dilated cardiomyopathy. Early detection and prompt cardiac supportive care and management are paramount and help to reduce morbidity and mortality.
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MEDICAL HISTORY PAGE Top

Em and the Big Hoom- A Psychiatrist's Perspective p. 89
Smitha Lamiya Rasquinha
DOI:10.4103/mjmsr.mjmsr_36_19  
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LETTER TO EDITOR Top

Improving the workplace conditions to successfully attain sustainable development goals p. 92
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_29_19  
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