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   Table of Contents - Current issue
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July-December 2020
Volume 11 | Issue 2
Page Nos. 47-105

Online since Tuesday, May 25, 2021

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ORIGINAL ARTICLES  

A study on knowledge, attitude, and practice of medical, paramedical, and dental students of a tertiary care institution toward consumption of fast foods Highly accessed article p. 47
Durga Prasad Patnana, Bhavana Chopparapu, Swathi Dulla, Lakshmi Venkata Simhachalam Kutikuppala
DOI:10.4103/mjmsr.mjmsr_10_20  
Background: Fast food generally refers to food that people intend to consume quickly either on- or off-site. Junk foods are foods that contain little or no proteins, vitamins, or minerals but are rich in salt, sugar, and fats and are high in energy (calories). Excess consumption of fast food has been linked with a variety of health problems including obesity and type II diabetes. Fast foods tend to contain high trans-fat levels which tend to raise amounts of low-density lipoprotein in the human body leading to ill effects on health. Aim: The aim of this study was to know the knowledge, attitude, and practice of medical, paramedical, and dental students toward consumption of fast foods. Materials and Methods: This study is carried out at Konaseema Institute of Medical Sciences and Research Foundation for 2 months among 658 students from medical, dental, and paramedical courses. Students were asked to fill a self-administered questionnaire, and acquisition of data from those filled questionnaires was done. Data entry and assessment were done in MS Excel and depicted as required. Results: Six hundred and fifty-eight students of medical, dental, Bachelor of Physiotherapy (BPT), and nursing courses participated in this study, out of which 421 (64%) are MBBS, 165 (25%) are BDS, 39 (6%) are BPT, and 33 (5%) are nursing students. Conclusion: Hygienic practices should be maintained at fast-food outlets and restaurants. A law postulating to label nutritional information for unpacked foods before serving should be implemented.
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Interobserver variation of psoriasis area and severity index in a clinical setting p. 50
Neema Sandra Dias, B Nanda Kishore, D Sukumar
DOI:10.4103/mjmsr.mjmsr_1_20  
Background: Severity scoring systems are important parameters in assessing the severity of a disease aiding in categorization of disease and its prompt treatment. However, reliability of these scoring systems and inter-observer variation is a concern. In the recent years, there has been a lot of debate on reliability of Psoriasis Area and Severity Index (PASI) scoring as there is a wide range of difference in the scoring when assessed by each observer. We conducted this study to assess the inter-observer variation of PASI scoring observed in out-patient department of Dermatology at a tertiary care hospital. Methods: Total of 35 patients clinically presenting with chronic plaque type psoriasis, irrespective of disease duration and treatment taken were enrolled in the study. PASI scoring was assessed by 3 different observers (2st year, 3nd year postgraduate residents and clinical staff) independently on each patient and reliability was determined by intra-class coefficient. (ICC). Results: Our study showed an excellent reproducibility of PASI score when an inter-observer variation was performed. Most of the parameters showed an agreement of >0.9 (ICC) which was statistically significant (<0.001). However it was noted that “erythema” in head, upper limbs and lower limbs was in less agreement with ICC when compared to other parameters, yet excellent. Mean PASI score was 10.96, 10.78 and 10.47 among observer 1, 2 and 3 respectively. Conclusion: Our study concludes that PASI is a reproducible and reliable clinical tool with less inter-observer variation if done by trained qualified observers to assess the severity of chronic plaque type psoriasis although its application gets tedious and difficult in busy dermatology clinics. Limitation: A small sample size.
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Measure what you treasure! – A maternity dashboard p. 55
Joanna Jyothsna, Prema D' Cunha, Chethana Bolanthakodi
DOI:10.4103/mjmsr.mjmsr_32_20  
Background: Clinical quality dashboards equip hospitals with a simple method for maintaining and monitoring clinical quality indicators. The maternity dashboard. provides an opportunity to integrate managerial, organizational, and clinical audits to improve quality of care. It has four broad categories: clinical activity, workforce, clinical outcome, and complaints/risk incidents. It can be used to benchmark activity and monitor performance against the standards agreed locally for the maternity unit on a monthly basis. Aim: The aim of this study was to design and implement a maternity dashboard to improve maternal and child health care. Settings and Design: This was a retrospective observational study conducted at a tertiary care hospital. Materials and Methods: Data were collected manually from outpatient department, labor ward, neonatal intensive care unit registers, and electronic records from June 2018 to May 2019 in a tertiary care hospital. Goals for each of the parameters were set, as well as upper and lower thresholds, and the data were analyzed. A suggested approach is to use the traffic light system, such as “green,” “amber,” and “red.” All the parameters after analyzing were noted on the dashboard. Results: During the study period of 1 year, there were 3750 deliveries. Auditing was done for various clinical activity indicators along with clinical outcome (both maternal and neonatal) and triaged using traffic light colors on a monthly basis. Conclusions: Maternity dashboard facilitates targeted quality improvement initiatives. They help in comparing current performance against expected standards and hence helpful in driving changes toward optimum maternal and child health.
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Role of fine-needle aspiration cytology in peripartum/pregnancy-associated breast malignancy - Six cases with review of literature p. 59
Priyadarshini Dehuri, Debasis Gochhait, Durga Devi
DOI:10.4103/mjmsr.mjmsr_9_20  
Background: The incidence of pregnancy associated breast cancers is on the rising trend in different parts of the world. There are occasional studies dealing with the fine needle aspiration cytology (FNAC) and clinicopathological characteristics of these tumors. Objectives: To study the cytomorphology and clinicopathological characteristics of pregnancy associated breast cancers and review the existing literature on the pathological characteristics. Methods: This is a retrospective study which includes cases of breast cancer which were diagnosed during peripartum period. FNAC was performed for all the cases from primary and metastatic sites along with correlation of the clinicopathological characteristics. Results: In the study group, 4 cases were lactating at the time of diagnosis, 1 patient presented at 37 weeks of her pregnancy and another patient presented 1 week after ruptured tubal ectopic pregnancy. Histologically two cases of infiltrating duct carcinoma -not otherwise specified (IDC-NOS), one case of invasive duct carcinoma with mucinous differentiation, one case of invasive duct carcinoma with concomitant lactating adenoma and one case each of metaplastic carcinoma and malignant phyllodes tumor. Only a single case was found to be positive for both the estrogen and progesterone receptors and another case only for estrogen receptors. None of the cases were found to positive for Her -2 neu. Conclusion: FNAC still serves as a reliable diagnostic measure inspite of the close mimics, especially when combined with cell block preparation. Further documentation of the clinicopathological features is essential for establishing the prognostic parameters and treatment guidelines for these peripartum breast cancers.
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Awareness and perception of physiotherapy practice among career educators in selected secondary schools in Nigeria p. 65
Samuel Olufemi Bolarinde, Temitope Victor Owoyemi, Ayodeji Ojo Obaya, Michael Nanimebila
DOI:10.4103/mjmsr.mjmsr_8_20  
Context: High school career educators educate and counsel senior students on choice of career. The pursuit of a career in physiotherapy depends largely on the information available to the students. Aims: The aim of the study is to investigate the level of awareness and perception of the physiotherapy profession among secondary school career educators. Settings and Design: The cross-sectional study recruited 49 secondary school career educators in both public and private secondary schools in Owo local government area of Ondo-state, South-western Nigeria. Subjects and Methods: A self-administered questionnaire was used to obtain information on the level of awareness and knowledge about physiotherapy. Statistical Analysis Used: Data were summarized using mean, standard deviation, frequency, and percentiles. Results: About 95.5% of school career educators are aware of physiotherapy. 77.6% are aware that physiotherapy can be studied in university, while others believe that it can be studied in polytechnic (4.1%), college of education (2.0%), and technical schools (6.1%). 51.0% knew about adequate subject combination for gaining admission to study physiotherapy, while 49.0% did not know about the adequate subject combination. The overall knowledge score of <48.0% among school career educators indicated inadequate knowledge about physiotherapy practice, treatment modalities, and specialties. Conclusions: Secondary school career educators in this study demonstrated a high level of awareness about physiotherapy. However, their knowledge about the practice of physiotherapy, treatment modalities, specialties, and employability in institutions other than government own health facilities remains inadequate. The professional body of physiotherapy should organize programs aimed at improving the knowledge of secondary school career educators about the practice of physiotherapy.
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REVIEW ARTICLES Top

A panoramic view of COVID-19: Epidemiology and challenges p. 71
Rhea Fernandez, Nikhita Suzanne Roshan, Anissa Mary Thomas Thattil
DOI:10.4103/mjmsr.mjmsr_23_20  
The rise of a novel disease agent is a complex situation that is fraught with fear and concern. The SARS-CoV-2 novel virus was identified in the Hubei province of China in December 2019, and since then, its rapid spread has become a matter of international concern. For this article, a literature search for the origin of the virus, mortality and morbidity data, pandemic influenzas in the past, modes of transmission, incubation period, vulnerable populations and clinical features, was conducted. Although evidence regarding the epidemiology of the disease is not thorough and is being studied further, this article aims to collate existing data and understand the epidemiology of COVID-19 while also trying to identify the global challenges that will have to be faced in the near future.
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Pandemics those struck and those averted: How humanity survived! p. 77
Madhurima K Nayak, Vijetha Shenoy Belle, Kashinath A Nayak
DOI:10.4103/mjmsr.mjmsr_15_20  
Humanity has been exposed to and challenged by epidemics and pandemics from times immemorial. Humans have either lost the battle or won over these pandemics. Bacterial pandemics such as typhoid, plague, and cholera wiped off cities and civilizations altogether. Notable viral pandemics include influenza and smallpox. Influenza has been etched in the history of mankind as a recurring pandemic due to its antigenic variation. A few viruses such as yellow fever, ebola, severe acute respiratory syndrome, Nipah virus, and Zika virus have caused epidemics in the new millennium, although they have been identified a long time back. Human immunodeficiency virus/AIDS is a slow pandemic present since the 1980s, and COVID 19 is the pandemic that the world is facing presently. An effort is made to recall, compare various infectious pandemics, and to understand how humanity has fought back. Furthermore, we try to unravel lessons from history, global, and local health measures such as GSIRS, International Health Regulations, and Global Outbreak Alert and Response Network that were introduced to tackle many such pandemics and an ongoing effort to overcome the present-day pandemic – COVID-19.
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CASE REPORTS Top

An unusual occurrence of synchronous gastrointestinal stromal tumor and high-grade serous carcinoma of the endometrium - A rare combination p. 87
Daphne Fonseca, Sahithi Shilpa Arya, K V. V. N. Raju
DOI:10.4103/mjmsr.mjmsr_35_20  
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract and comprise <2.2% of all GI tumors. The incidence of endometrial cancer in India is 1.2%. Among synchronous cancers, female genital tract tumors, mostly endometrioid/ovarian carcinomas, constitute 5% of GIST patients. We describe an unusual case with synchronous occurrence of GIST of the stomach with high-grade serous carcinoma (HGSC) of the endometrium, which was proven by histopathological examination and further confirmed by immunohistochemistry. This is the first case published so far of a patient with synchronous occurrence of low-risk GIST of the stomach with HGSC of the endometrium. The main objective of the study is to present a unique case because we have not found any reports for coexistence of the described neoplasm as in our patient, and we hope that it will be valuable in future investigations about the genesis, diagnosis, and treatment of these types of tumors.
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Primary anorectal melanoma: Multimodality management in a series of four cases and review of literature p. 91
Nishant Lohia, Manoj Prashar, S Harish, Sankalp Singh, Anand Subramananiam, Sundaram Viswanath, Richa Ranjan, Gaurav Trivedi
DOI:10.4103/mjmsr.mjmsr_37_20  
Anorectal melanoma is a very rare and aggressive mucosal melanocytic malignancy, accounting for 1% of all anorectal cancers. There have only been a few cases reported. Surgical resection remains the mainstay of treatment. No definitive management strategies exist because of the absence of randomized trials. We here report a case series on four cases of anorectal melanoma. All four cases underwent abdominoperineal resection (APR) and nodal dissection. Two out of four cases received adjuvant temozolomide (TMZ), one case received adjuvant doublet chemotherapy with TMZ and cisplatin, and the fourth case succumbed to nononcological disease before he could be subjected to adjuvant chemotherapy. In the first and third case, nodal dissection was limited to pelvic nodes only. However, in the second case, extensive nodal dissection in the form of bilateral pelvic and inguinal lymph nodal dissection and para-aortic lymph nodal dissection was performed. The fourth case also was subjected to extensive nodal dissection in form of bilateral pelvic and para-aortic lymph node dissection. The first patient however became metastatic at the end of first cycle of adjuvant TMZ and succumbed to his illness post 3 months of surgery. The second patient could complete all six cycles of adjuvant TMZ, and after 1 year of completion of adjuvant TMZ, he presented with skeletal and brain metastases. He also received palliative whole-brain radiotherapy for brain metastases. He finally succumbed to his disease 18 months after surgery. The third case completed all six cycles of adjuvant TMZ and is still alive with disease-free interval of around 1 year. The fourth case succumbed to nononcological death around 1 month after surgery.
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Ovarian hyperstimulation syndrome following natural conception p. 96
Swati Garg, Arpita Jain, Urvashi Sharma, Vatsal Thakral
DOI:10.4103/mjmsr.mjmsr_2_20  
Ovarian hyperstimulation syndrome (OHSS) is a disorder that usually occurs with ovulation induction. It is rare in pregnant women and only a very few cases have been reported in spontaneous unstimulated conceptions. We report a case of spontaneous OHSS with primary hypothyroidism in a 19-year-old primigravida, where the imaging and laboratory findings confirmed the diagnosis of “Van Wyk–Grumbach syndrome” with pregnancy. This rare event in pregnancy needs attention, as early institution of thyroid hormone replacement therapy results in resolution of cysts and avoids unnecessary evaluation and surgical misadventures.
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Aspergillus nodule, a rare variant of chronic pulmonary aspergillosis mimicking as lung cancer p. 99
Manoj Kumar Pandey, Hemant Kumar, Poornima Mishra, Shyam Murari Kalra, Preeti Gupta
DOI:10.4103/mjmsr.mjmsr_29_20  
Chronic pulmonary aspergillosis includes several disease manifestations, including aspergilloma, Aspergillus nodules, chronic cavitary pulmonary aspergillosis, and chronic fibrosing pulmonary aspergillosis. Although rarely reported in the literature, Aspergillus nodules can occur in immunocompetent hosts, may be single or multiple, and may or may not have cavitation within them. Because of similar clinical presentation of Aspergillus nodule and lung cancer, the diagnosis of Aspergillus nodule becomes delayed leading to increased mortality and morbidity. Here, we are reporting a case of lung nodule initially suspected for lung carcinoma but turn out to be an Aspergillus nodule after histopathological examination.
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The role of magnetic resonance imaging in the diagnosis of bilateral laryngocele p. 102
Ebbi Donald Robinson, Chidinma Wekhe
DOI:10.4103/mjmsr.mjmsr_39_20  
Laryngocele is a rare anomalous air-filled dilatation of the saccule of the larynx with unclear etiology. The patient in our case presented with a complaint of a painless anterior neck swelling which moved and increased in size on coughing, swallowing, and straining. Physical examination revealed a compressible swelling measuring approximately 2 cm in the widest diameter in the anterior aspect of the neck with normal overlying skin. It was nontender, soft, cystic, fluctuant, and mobile. The advent of magnetic resonance imaging (MRI) has made its diagnosis easier than the use of laryngoscope. The finding revealed multiple, nonenhancing, oval-shaped but lobulated masses in both infrahyoid visceral spaces involving the paraglottic space with an extralaryngeal component. They hypo to isointense on T1-weighted and hyperintense on T2-weighted and short tau inversion recovery images and measured 3.71 cm × 3.06 cm in the right and 1.27 cm × 1.04 cm in the left (right bigger than left). Hence, a diagnosis of bilateral laryngocele was made. In the index report, MRI being a noninvasive imaging modality using radiofrequency with brilliant soft-tissue contrast and spatial resolution was used to diagnose the lesion. The paucity of literature and information with regard to bilateral laryngocele in our environment and the role of MRI have informed this report.
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