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   Table of Contents - Current issue
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January-June 2020
Volume 11 | Issue 1
Page Nos. 1-45

Online since Wednesday, December 23, 2020

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ORIGINAL ARTICLES  

Electroconvulsive therapy: Knowledge and attitudes among medical interns and the general public Highly accessed article p. 1
Bilal Ahmad Bhat, Shabir Ahmad Dar, Arshad Hussain, Rouf Ahmad Mir
DOI:10.4103/mjmsr.mjmsr_5_20  
Background: Negative view of electroconvulsive therapy (ECT) is held not only by the general public but also by the medical professionals. Aims: The study aims to assess knowledge of ECT and attitude toward it in medical interns and general public. Materials and Methods: This was a cross-sectional study in which knowledge of ECT and attitude toward this treatment was assessed in medical interns and general public using ECT knowledge and attitude questionnaire. A total of 36 participants from each group were included in the study. Results: Among the medical interns, 75% reported the source of information as medical books, whereas in general public, 88.9% reported the primary source of information as media. Our participants, from both groups, were more knowledgeable about the consent, side effects, and procedure part of the questionnaire compared to other parts of it. The mean score for knowledge questionnaire was 16.58 ± 4.78 and 9.94 ± 4.82 for medical interns and general public, respectively (t = 3.74; P = 0.001). The mean score on attitude questionnaire was 9.94 ± 4.82 and 0.83 ± 8.56 for medical interns and general public, respectively (t = 5.56; P = 0.0001). In both medical interns and general public, the total score on knowledge questionnaire and total score on attitude questionnaire were correlated positively (rs = 0.542, P < 0.001 and rs = 0.446, P < 0.006, respectively). Conclusion: Our study found a low knowledge of ECT in general public with less favorable attitude toward this treatment. With a good knowledge of ECT and more favorable attitude in medical students, still there are lacunae in them. However, in both these groups, there was a positive correlation between knowledge and favorable attitude.
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The utility of crab shell powder in the treatment of rickets Highly accessed article p. 8
Ri Gon, Mi-Ra Pak, Ok-Son Ri, Hyok Kim
DOI:10.4103/mjmsr.mjmsr_22_19  
Purpose: To estimate the effect of treatment for rickets by crab shell powder (CSP). Objects and Methods: We supplied children with rickets with calcium lactate and CSP and observed the serum concentrations of calcium, phosphorus, alkaline phosphatase (ALP) in preadministration and postadministration. Results: Postadministration serum concentrations of calcium, phosphorus, and ALP increased significantly compared to preadministration in both groups (P < 0.05), but significance between two groups is not recognized. Conclusion: The effective ratio of calcium lactate and CSP in the treatment for rickets has no difference, but CSP markedly decreased the incidence of concomitant disorders compared with calcium lactate.
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Correlation of cord blood glycated hemoglobin with macrosomia and neonatal hypoglycemia in infants born to diabetic mothers p. 12
Sujonitha John, Habeeb Ullah Khan, Jaidev Mangalore Devdas, Pavan Hegde
DOI:10.4103/mjmsr.mjmsr_24_20  
Background: Infants born to diabetic mothers are prone to hypoglycemia once transplacental supply of glucose is cut off due to which there is transient low blood glucose concentration during the first 2 h after delivery. Aim: Our study aimed at the correlation of cord blood glycated hemoglobin (HbA1c) with neonatal hypoglycemia and macrosomia in infants of diabetic mothers (IDMs). Methods: A descriptive longitudinal study was conducted on 100 consecutive IDMs with gestational age >34 weeks in a tertiary care hospital between November 2016 and December 2017, meeting the inclusion criteria. Infant and maternal details were recorded in a predesigned pro forma. Cord blood HbA1c in IDMs correlated with neonatal hypoglycemia and macrosomia. Results: Out of the 100 IDMs, 33 babies developed hypoglycemia. The mean cord blood HbA1c among hypoglycemic babies was 6.4% ± 0.9%, which was higher and statistically highly significant (P < 0.001) than babies who did not develop hypoglycemia. Most hypoglycemic events occurred at 30 min of postnatal life. The birth weight of IDMs correlated with cord blood HbA1c levels. Out of the 33 babies with hypoglycemia, 31 (94%) were macrosomic. Macrosomia increased the risk of hypoglycemia in IDMs (odds ratio: 78, 95% confidence interval: 16.4–379). Conclusion: Cord blood HbA1c showed a significant correlation with the risk of macrosomia and neonatal hypoglycemia.
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Cardiorespiratory fitness of medical students in a health institute in Eastern India p. 16
Sunil Kumar Jena
DOI:10.4103/mjmsr.mjmsr_38_20  
Background: VO2 max is the single most reliable indicator of cardiorespiratory fitness (CRF). More is the VO2 max more is the CRF and aerobic capacity of an individual. The status of CRF ultimately indicates the physical fitness. This study was conceptualized to estimate the CRF of medical students. Materials and Methods: This study included 161 apparently healthy participants, which included 101 male and 60 female MBBS students. The study was started after approval of the ethics committee. Each participant was clearly understood the study protocol and its output. Each participant signed the written consent form. Body weight was estimated without shoes and light clothing. The resting heart rate (RHR) was calculated by palpating radial pulse. VO2 max was determined by a predefined predicted equation using three factors, i.e., age, body weight, and RHR. VO2 max = 3.542+ (−0.014 × age in year) + (0.015 × body weight [kg]) + (−0.011 × RHR). Statistical analysis was done by unpaired test. Results: Mean VO2 max of male and female was 56.4 ± 4 and 51.9 ± 6 ml/kg/min, respectively. This difference was significant at P = 0.000. 26.7%, 28.7%, and 26.7% of males were good, excellent, and superior, respectively, in VO2 max. 13.3%, 8.3%, and 70% of females were good, excellent, and superior, respectively, in VO2 max. 21.7%, 21.1%, and 42.8% of total participants were good, excellent, and superior, respectively, in VO2 max. Conclusion: CRF of male was better than female. The majority of students' CRF was up to mark and minimal students need care to improve their CRF.
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Extranodal NK/T-cell lymphoma-nasal type: Experience from a regional cancer center in India p. 20
Smitha Carol Saldanha, Pravin Ashok Khandare, Lokanatha Dasappa, Linu Abraham Jacob, M C Suresh Babu, KN Lokesh, MN Suma
DOI:10.4103/mjmsr.mjmsr_39_19  
Introduction: Extranodal natural killer/T-cell lymphoma-nasal type (ENKTL-NT) is an aggressive rare non-Hodgkin's lymphoma (NHL) subtype. It presents with involvement of the nasal and upper aerodigestive region causing extensive destruction of these midline structures. It has a predilection for the Asian population. Most cases present in the early-stage disease. Treatment outcomes are usually poor, and no consensus for optimal treatment strategy exists. Patients and Methods: This is a retrospective analysis of ENKTL-NT, diagnosed in a regional cancer center in India during the period of 2013–2018. The demographic and clinical features, laboratory parameters, radiological, histopathological features, and treatment outcomes were studied. Patients were treated with SMILE or AspaMetDex regimes sandwiched with radiotherapy. Statistical analysis was performed using software “Epi Info” Version 7.2, (CDC, Atlanta, Georgia, USA). Results: Fourteen patients were diagnosed with ENKTL-NT during this period. Eight patients received SMILE, and six patients have received AspaMetDex as induction chemotherapy. Ten (71.42%) of 14 patients have achieved CR. At the median follow-up of 30 months (4–47 months), nine patients relapsed with median progression-free survival of 22 months. The median overall survival was not reached. There were two induction deaths, one in AspaMetDex and one in the SMILE group. All patients receiving SMILE experienced at least one episode of Grade 3/4 hematological toxicity. Patients receiving AspaMetDex did not have any Grade 3/4 hematological toxicity. Discussion: ENKTL-NT in India is not as common as reported in other Asian countries. Patients usually present at an earlier stage because of the peculiar site of affection. It has high response rates, but relapses are common. Most of the relapses occur within the first 2 years of follow-up. Conclusion: ENKTL-NT is rare aggressive NHL subtype with good response to L-asparaginase-based chemotherapy sandwiched with radiation therapy. SMILE is a more toxic regime than AspaMetDex but can be managed with proper supportive care.
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Interobserver agreement of pallor in detection of anemia p. 26
K Divyakrishnan, K Shreedhara Avabratha, Amita Jane D'Souza
DOI:10.4103/mjmsr.mjmsr_28_20  
Introduction: The diagnosis and management of anemia largely depends on clinical assessment of pallor. There are varied opinions regarding the subjective variation in the assessment of pallor. Objective: The objective is to study the interobserver agreement of pallor between two independent observers. Methodology: This observational study done in a medical college hospital on 50 children in the age group of 6 months to 5 years. Pallor was assessed in four sites namely conjunctiva, tongue, nail bed, and palm. When pallor was present, it was graded as definitely present and borderline. Second examiner independently assessed the pallor at all four sites within an hour. Statistical analysis was done by percentage and kappa value. Results: Out of 50 children aged between 6 months to 5 years, 30 were male and 20 were female. Eleven were infants of 6 months to 12 months, 19 children were between 1 and 3 years and 20 children were 3–5 years of age group. Twenty-eight children had anemia with hemoglobin <11 g/dl. Kappa value for conjunctival and nailbed assessment of pallor were 0.484 and 0.441, respectively, indicating good agreement. The value was 0.644 and 0.73 for tongue pallor and palmar pallor respectively suggesting very good agreement. Conclusion: Interobserver agreement was found to be good in the evaluation of pallor. Palmar and tongue pallor had better agreement than conjunctival and nailbed pallor in our study. By assessing in all four sites, for pallor interobserver variability can be minimized.
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A controlled study on serum lipid parameters in individuals with and without major depressive disorder p. 29
Bilal Ahmad Bhat, Shabir Ahmad Dar, Arshad Hussain
DOI:10.4103/mjmsr.mjmsr_26_19  
Background: Evidence seems to suggest that dysfunction in many biological functions is associated with major depressive disorder (MDD). Literature suggests a possible link between different lipid parameters and depression. Aims: The aim was to study lipid parameters in patients with MDD and to find a correlation between these lipid parameters and depression. Settings and Design: This was a case–control study conducted in outpatient services of the department of psychiatry. Materials and Methods: A total of 100 participants were included in this study. Fifty drug-naïve depression cases as assessed clinically and with Hamilton rating scale for depression were included in the study group, whereas control group comprised fifty normal individuals. Lipid parameters were obtained from fasting blood samples in both groups. Statistical Analysis: Data analysis was performed using SPSS 16 software. Continuous variables were summarized as mean and standard deviation, whereas categorical variables were summarized as frequency and percentage. Results: The mean total cholesterol (TC) and the mean low-density lipoprotein cholesterol (LDL-C) were significantly low in the study group than the control group. When compared with severity of depression, there was a significant negative correlation with TC (r = −0.710; P = 0.0001), LDL-C (r = −0.608; P = 0.0001), and triglycerides (TG) (r = −0.289; P = 0.042). Conclusions: Drug-naïve individuals with MDD had significantly low TC and LDL-C in comparison to normal individuals. There was a significant negative correlation between the severity of depression and TC, LDL-C, and TG.
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CASE REPORTS Top

Facial baroparesis in a 12-year-old boy p. 34
Santosh Kumar Swain, Nishtha Anand
DOI:10.4103/mjmsr.mjmsr_16_20  
Facial baroparesis is an extremely uncommon clinical entity that occurs due to the middle ear barotrauma. It is rarely reported in the medical literature which can happen among persons who ascend to high altitude in flight or by scuba diving. The overpressure in the middle ear space due to eustachian tube dysfunction may cause exertion of the high pressure over the facial nerve through dehiscence of the horizontal segment of the facial nerve leading to facial nerve paralysis. Clinical history plays a vital role in diagnosis and also sometimes imaging helps confirm this rare cause of facial nerve paralysis. Here, we report a case of a 12-year-old boy who experiences unilateral facial nerve paralysis upon ascent to altitude on a flight with relieves from symptoms shortly after the descent.
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Vulvovaginal fibroepithelial stromal polyp with myxoid stroma: A diagnostic dilemma on histology – Report of two cases p. 37
Urvashi Ghosh, Debahuti Mohapatra, Nibedita Sahoo
DOI:10.4103/mjmsr.mjmsr_27_20  
Genital stromal tumors are a rare and unique subset of soft-tissue tumors encountered in the vulvovaginal and inguinoscrotal region and this group includes fibroepithelial stromal polyp, superficial (cervicovaginal) myofibroblastoma, cellular angiofibroma, mammary-type myofibroblastoma, angiomyofibroblastoma, superficial angiomyxoma, and deep/aggressive angiomyxoma. The relative rarity and overlapping histomorphological and immunohistochemical features result in a diagnostic difficulty for the pathologists. Herein, we describe two cases of soft-tissue tumors in the vulvovaginal region presenting as polypoidal mass with detailed histopathology and immunohistochemical workup.
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SHORT COMMUNICATIONS Top

Improving physical activity among adolescents through multisectoral actions: World Health Organization p. 40
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_25_20  
Insufficient physical activity has been regarded as one among the potential risk factors for the development of non-communicable diseases and the associated complications, including mortality. The World Health Organization has recommended for at least 60 minutes of physical activity per day for adolescents. In the global mission to improve the levels of physical activity and to reduce the percentage of insufficient physical activity by 10% by 2025, there is an immense need to formulate effective strategies and programs for the benefit of adolescents. At the same time, it is extremely important to implement multi-sectoral actions, which will then offer varied chances for adolescents and youths to be physically active. In conclusion, physical activity is an important aspect to ensure optimal health and wellbeing in all age-groups. It is the need of the hour that nations and communities should implement measures to enhance the number of opportunities available for adolescents to be physically active.
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Corona virus disease-2019 pandemic: Ensuring delivery of essential HIV services p. 42
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_31_20  
The corona virus disease-2019 (COVID-19) pandemic has been reported among all the age-groups, with severity being highest among elderly people and those with some pre-existing illnesses. The available evidence has not suggested that a person living with HIV (PLHIV) has a higher risk of acquisition of infection or the development of serious complications if they do get infected with COVID-19, provided their immune system is not compromised. Amidst dealing with this COVID-19 emergency, it is quite possible that delivery of essential health services, including those required for PLHIV will be temporarily interrupted. In these times of emergency, we should aim for reducing the number of visits to the ART center and inform them about the disease. In conclusion, the COVID-19 pandemic is bound to impact the delivery of essential services for PLHIVs and thus it is our utmost responsibility to improve the resilience of the health system to ensure that appropriate strategies are adopted to ensure the uninterrupted supply of the essential services are offered to these vulnerable population groups.
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Sustaining the delivery of essential services among the ongoing coronavirus disease 2019 pandemic p. 44
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_13_20  
The Corona Virus Disease-2019 (COVID-19) pandemic has produced a massive impact on the health care delivery system and on the daily routine of the general population. Owing to the massive load on the health sector due to the ongoing outbreak, most of the health systems have been stretched beyond their capacity and capability. This is not a good sign considering the fact that if the health system is exhausted, obviously the incidence of vaccine-preventable diseases and other treatable conditions will show a significant rise. In conclusion, amidst the ongoing battle against the COVID-19 pandemic, it is a must that the delivery of essential health services in the community is also sustained. Even though, it is a difficult ask from the health authorities, proper planning and awareness can definitely help us in the delivery of an accelerated response to COVID-19 and also not jeopardize the delivery of essential services.
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