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   Table of Contents - Current issue
January-June 2022
Volume 12 | Issue 1
Page Nos. 1-48

Online since Monday, April 18, 2022

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Sickle cell anemia and its complications p. 1
Anupam Dutta
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Pulmonary hypertension in people with sickle cell disease in a Nigerian tertiary hospital p. 3
Abiona Oluwadamilola Odeyemi, Opeyemi Olalekan Oni, Abimbola Ololade Odeyemi, Kehinde Joyce Olufemi-Aworinde, Oluwabukola Ayodele Ala, Ademola Toyosi Abolarin
Objectives: The aim of this article is to estimate the prevalence of pulmonary hypertension (PHTN) among patients with sickle cell disease (SCD) and to determine the associated factors. Materials and Methods: It was a hospital-based cross-sectional study involving 113 SCD participants in their steady state. Transthoracic echocardiography was done in accordance with the American Society of Echocardiography (ASE) guidelines to determine the peak tricuspid regurgitant velocity (TRVmax); complete blood count, oxygen saturation, serum creatinine, and urea were also done for all the participants. Results: The participants had a mean age of 18.1 ± 9.85 years, and 64 (56.6%) of them were males. Seven (6.2%) of the participants had PHTN as determined by a TRVmax of ≥2.5 m/s. PHTN was significantly associated with age, sex, body mass index (BMI), blood pressure, oxygen saturation, and serum creatinine. Conclusion: PHTN remains common among patients with SCD and it is associated with female gender, increasing age, a rising BMI, blood pressure and serum creatinine, and a decreasing oxygen saturation and hematocrit. We recommend regular screening of patients with SCD for PHTN and that these associated factors should be taken into consideration when screening SCD patients for PHTN.
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Prevalence of Mycobacterium tuberculosis in patients suffering from chronic respiratory diseases in a tertiary care hospital using Gene Xpert as the diagnostic tool p. 10
Baishali Das, Dina Raja
Background: Chronic respiratory diseases constitute a grave problem throughout the world and particularly in the middle- and low-income countries. The burden of these diseases leads to poor quality of life and disability of affected individuals leading to premature deaths and a great economic loss to their families and society. Tuberculosis remains one of the deadliest communicable diseases. Though culture is the gold standard for the diagnosis of tuberculosis, the long period of time required for a positive result leads to the transmission of the disease in the community. Objective: The study was conducted to study the prevalence of Mycobacterium tuberculosis in patients suffering from chronic respiratory diseases. Materials and Methods: Bronchoalveolar lavage fluid samples of patients with chronic respiratory diseases undergoing bronchoscopy were collected under aseptic conditions after obtaining approval from the Institutional Ethics Committee. Each sample was subjected to Ziehl Neelsen stain and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) on Xpert MTB/RIF manufactured by Cepheid (Sunnyvale, CA). Results: Eighteen of 110 cases (16.36%) showed the presence of M. tuberculosis in the samples, of which rifampicin resistance was detected in 2 (11.11%) cases. Conclusions: M. tuberculosis remains a common underlying pathogen in the cases of chronic respiratory diseases.
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A clinical and bacteriological study on patients presented with acute diarrhea admitted in Silchar Medical College and Hospital, Cachar District, Assam p. 14
Paramita Roy, Subhrendu Sekhar Sen, Pushpita Barman
Background: Acute diarrheal infection is a leading cause of outpatient visits, hospitalizations, and lost quality of life. It is defined as the passage of three or more loose or liquid stools per day. The Centers for Disease Control and Prevention (CDC) has estimated 47.8 million cases occurring annually in the United States. According to NFHS-5, the prevalence of diarrhea among under-five children in Assam is 5.5%. Aims and Objective: The aim of this work was to study the clinical and bacteriological spectrum in the recent outbreak of acute gastroenteritis in Silchar Medical College and Hospital. Materials and Methods: A cross-sectional study was conducted on patients with diarrhea admitted in the Medicine Department of Silchar Medical College and Hospital for the time period of January 2016 to March 2016. Result: In our study, a total of 327 patients were enrolled. The median age of patients was 36 years with the majority being female and belong to Hindu religion. All were presented with loose stool, followed by vomiting (85%). The most common pathogen isolated from stool was Escherichia coli (71.2%) followed by Klebsiella (16.2%). More than 50% of cases with E. coli infection are resistant to Piperacillin, Doxycycline, while in cases with Klebsiella infection, more than 50% are resistant to Doxycycline followed by Azithromycin. Conclusion: This study may provide valuable information about the clinical features and microbiology of patients with diarrheal diseases to the Medical practitioners which might help in diagnosis and management.
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To study the correlation of chronic obstructive pulmonary disease (COPD) assessment test, clinical COPD questionnaire, and BODE index in patients of stable COPD p. 18
Amanpreet Kaur, Amit Goyal, Naveen Pandhi
Background: Chronic obstructive pulmonary disease (COPD) assessment has emerged as one of the most important parts of COPD treatment. Therefore, a thorough assessment of symptoms is necessary rather than just a measure of dyspnea. Objective: The aim of this study is to assess the disease severity and health status in stable patients of COPD using COPD assessment test (CAT), clinical COPD questionnaire (CCQ) scores, and BODE index and to correlate these indices. Materials and Methods: The study included 100 stable patients suffering from COPD attending outpatient department subjected to CAT, CCQ, and BODE index. Results: CAT and CCQ score correlated significantly (r = 0.52, P < 0.001) and both with the BODE index (r = 0.68; CAT and r = 0.64; CCQ, P < 0.001). COPD severity status and BODE component and forced expiratory volume 1% (FEV1%)-predicted values correlated significantly with individual scores (r = −0.24, CAT; r = −0.41, CCQ; r = −0.72, BODE). Conclusion: An evident negative correlation of FEV1% predicted by CAT and CCQ among study subjects proved both questionnaires as sensitive, simple, and reliable tools not only for early recognition and assessing health status in COPD patients but also for planning appropriate treatment. The BODE index is more objective to assess the disease severity in COPD.
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Consequences of COVID-19 pandemic on the mental health of general population in India p. 24
Himavathy Kodandarao Gara, Dharma Rao Vanamali, Suryaveeramani Kartheek Adhikarla
Background: COVID-19 pandemic poses a challenge to mental health. The perception of stress and its adaptation are determined by individual’s risk perception and coping mechanisms. Aim: The study aimed to evaluate the perceived stress and behavioral responses owing to COVID-19 pandemic. Materials and Methods: The online survey recruited 621 respondents. The survey included (1) sociodemographic variables, (2) Perceived Stress Scale (PSS)-10 item inventory, (3) four items on experience of stress, and (4) eight items on mental health-related lifestyle changes and societal support during the pandemic. Results: Out of 621, majority were females (54.1%) and belonged to the age group of 18–30 years (66.02%). Moderate perceived stress was observed in 67.1% of the respondents. The mean PSS scores were significantly higher among females, age group of 18–30 years, unmarried, educational qualification below undergraduation, and students. Higher perception of work and financial stress were present in 52.67% and 48.3%, respectively. Increased concern about family and vulnerability was confirmed by 89.05% and 54.59%, respectively. Increased work stress was negatively associated with attention toward mental health, emotional support, physical activity, and hobbies. Greater concern for family and vulnerability had showed positive association with attention toward mental health, emotional support, and protective behavior. Conclusion: In COVID-19 pandemic, females, younger age, and students had significantly higher stress perception. Work and financial stress were associated with maladaptive responses, whereas concern about family and feeling vulnerable were accompanied by positive adaptive responses. Thus, evaluating the cognitive and behavioral responses to stressors is imperative to quantify individual’s stress perception during exposure to a stressful situation such as pandemic.
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Weil’s disease: A diagnostic dilemma p. 34
Trinayani Barua, Anupam Dutta, Sreemanta Madhab Baruah, Sanchu T K Sreeraj, Arijit Das
Leptospirosis is a zoonotic disease that predominantly occurs in tropical and subtropical areas. It is caused by the spirochete Leptospira interrogans complex and may lead to syndromes that can vary from a subclinical infection or a mild febrile infection to a severe icterohemorrhagic condition. This is a case report on a 52-year-old farmer who had presented with upper gastrointestinal (GI) bleed. He was initially thought to be a case of complications of Chronic Liver Disease. However, he was later found to have icterus, renal failure, and hemorrhagic manifestations and his IgM ELISA for leptospira was positive. It was later confirmed by MAT. He was treated with antibacterials and supportive measures and his clinical and biochemical parameters improved. The occurrence of Weil’s disease in the month of November and its occurrence in the state of Assam, India was unpredictable and hence posed as a diagnostic dilemma. It is a curable disease and hence needs timely intervention and treatment. This highlights the need for a better understanding of the natural course of this disease and improvement of public health measures.
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Fever: A diagnostic dilemma p. 37
Prasanta Dihingia, Sagar Kanta, Anshu Kumar Jha
Fever is one of the most common presentations of Systemic Lupus Erythematosus (SLE) (95%) but it is also associated with other manifestations. A 32-year-old female patient who presented with chief complaints of fever and burning micturition and during the course of the stay developed different manifestations like facial rash, leukopenia, proteinuria, and SLE was diagnosed on the antinuclear antibody (ANA) profiling of the patient and the clinical criteria. Here we present a case where the patient presented mainly with urinary tract infection which in turn acted as a trigger for immune reaction leading to the full-blown SLE.
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Zinc and mucormycosis—Fact vs myth check p. 40
Shibu Sasidharan, Harpreet S Dhillon
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A case of COVID-19 pneumonia coinfected with severe mixed complicated malaria p. 43
Shalendra Singh, Ravi Wadke, Samveda Shirish Samel, S Ushakiran Singh
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Self-directed learning in medical education and its implementation in medical schools p. 45
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
The delivery of medical education is a complex process, wherein we aim toward not only the acquisition of desired knowledge and skills, but also creating a system and cadre of healthcare personnel who possess the traits of being professional, leader, team-worker, and a lifelong learner. Self-directed learning (SDL) has been regarded as an important aspect of lifelong learning and is one of the core competencies expected of a medical graduate. Most of the regulatory bodies across the globe strongly advocate for the inclusion of SDL activities within the medical school curriculum. The overall process of implementation and faculty training can be supervised by the Medical Education Unit of the institution, along with the members of the Curriculum Committee and phase-wise faculty members. In conclusion, SDL is an essential attribute to ensure lifelong learning among medical students. Considering the wide range of benefits associated with SDL, it is crucial that all the steps are planned and implemented in a systematic manner to enable successful implementation.
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Medical quiz p. 48

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