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   Table of Contents - Current issue
January-March 2021
Volume 17 | Issue 1
Page Nos. 1-27

Online since Tuesday, May 18, 2021

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Factors associated with stroke burden in India Highly accessed article p. 1
Manas Pratim Roy
Objective: Stroke is one of the largest public health challenges in India. Several factors have been implicated for stroke. The present paper aims to explore associated factors from nationally representative data. Among different variables, smoking, alcohol, smokeless tobacco (SLT), second-hand smoking (SHS), use of clean fuel, and economic condition were considered. Methods: Data were taken from three reports – National Family Health Survey 4, Global Adult Tobacco Survey 2: India 2016–17, and India: Health of the Nation's States. The state-wise analysis was done. Spearman's correlation coefficient and multivariate linear regression were used. Results: Five states from the eastern part of India, viz., West Bengal, Odisha, Tripura, Assam, and Chhattisgarh, recorded the highest burden of stroke. The use of SLT was significantly related to stroke burden (r 0.476). Clean fuel and better economic conditions were found to reduce stroke burden (r S722;0.449 and − 0.363, respectively). SLT (B 21.029, P = 0.011) and SHS at work (B 25.905, P = 0.030) were associated with stroke burden significantly. Conclusion: States with the highest proportion of SLT need special intervention to reduce stroke burden in the country.
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Prevalence of drug-induced liver injury in patients on antitubercular therapy p. 5
Anuj Singhal, Sonal Singh, Arun Kumar Yadav, Amar Tej Atal, Shubham Shukla
Background: As per the World Health Organization Global Tuberculosis (TB) Report 2019, there were an estimated 10.0 million new TB cases worldwide in 2018, with India (27%) having the maximum burden of the disease. Drug-induced liver injury (DILI) due to antitubercular treatment (ATT) is a serious adverse effect and a major cause of discontinuation of ATT, leading to increased drug resistance, morbidity, and mortality. Methodology: This was an observational study that was conducted at a tertiary care center in South Maharashtra having a dedicated TB nodal center. All newly detected cases of pulmonary and extrapulmonary TB and cases of TB after relapse/failure/treatment after default, who reported to this nodal center from January 2019 to June 2019 and in whom Category 1 and Category 2 ATT was started as per the Revised National Tuberculosis Programme protocol, were enrolled in this study. Results: Out of 100 enrolled patients, 10 (10%) were diagnosed to have ATT-induced DILI, which is concordant with other studies. No deaths were recorded. However, there was no statistically significant difference between male and female patients who developed DILI (12% males vs. 8% females). No correlation was found with body mass index or alcohol consumption. Conclusion: A fine balance should be struck between unnecessary discontinuation of ATT and continued safe treatment. Patient and staff education, careful selection of regimen, and close monitoring of risk factors will minimize cases of DILI.
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Autologous platelet-rich fibrin in the management of recurrent complex fistula in ano: A novel safer and cost-effective approach p. 9
Riju Ramachandran, Anoop Vasudevan Pillai, Vaishnavi Gunasekharan, Suyambu Raja, Veena Shenoy
We present the case of a 26-year-old female with Crohn's disease who had undergone multiple procedures for recurrent complex fistula-in-ano now presenting with recurrent discharge for 3 months. She underwent video-assisted anal fistula treatment (VAAFT) in our department 2 years back. The patient had financial issues and was unwilling for another sitting of VAAFT. Hence, we tried autologous platelet-rich fibrin (PRF) as a more economical alternative to fibrin sealant used in VAAFT. The patient had a very comfortable postoperative period and the fistula healed well in 3 weeks. We present this case report to highlight a new indication for autologous PRF which is already in use in healing many other types of wounds.
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Ascariasis presenting as acute cholangitis due to common bile duct stone p. 13
Pandiaraja Jayabal, Shalini Arumugam<
Ascaris lumbricoides is an intestinal parasite, more common habitant of the small intestine, particularly in the jejunum. It can produce a variety of presentations starting from anemia, gastrointestinal bleeding, intestinal obstruction, perforations, intussusception, and rarely obstructive jaundice. Obstructive jaundice is mainly due to proximal migration of the parasite into the biliary tree and causing an obstruction. It is the most common following biliary procedure. Here, we report the case of obstructive jaundice and cholangitis due to biliary ascariasis in a patient without any prior biliary procedure. Prompt intervention is needed in those cases of ascariasis with biliary sepsis. The patient has been managed by emergency cholecystectomy with common bile duct exploration and T-tube insertion.
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A rare case of glutaric acidemia type 2 with psychosis p. 16
Praveen Arathil, Ariya Nair
Glutaric acidemia type 2 (GAII), also known as glutaric aciduria, is a rare type of inherited disorder, in which the body is unable to process certain proteins properly. Presentation can vary from mild myopathy to metabolic acidosis or cardiomyopathy, as well as neurological complications. However, psychiatric manifestations have not been reported. The present case describes one such instance where a young male presenting with symptoms of psychosis with underlying metabolic disorder was diagnosed with GAII. Issues concerning the adequate administration of psychotropic medication have also been addressed.
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Intradural disc migration as a complication of chronic disc prolapse p. 18
Manoj Dayalal Singrakhia, I Ibad Sha
Intradural migration of extruded disc is a rare phenomenon. The multiple anatomical barriers including annulus fibrosus, posterior longitudinal ligament, and dural sheath which limit migration of the intervertebral disc material are breached when this happens. It usually happens in case of disc prolapse of prolonged duration. We here report a rare case of dorsal intradural migration of an extruded disc fragment. The report is to emphasize the importance of proper preoperative evaluation and high clinical suspicion needed for preoperative diagnosis of this entity and to plan the treatment accordingly.
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Cerebral venous sinus thrombosis as an uncommon presentation of polycythemia vera p. 21
Manoj Kumar Yadav, Rajeev Saxena, Hariprasadh Nagarajan, Chander Bhan Godara
Cerebral venous sinus thrombosis (CVST) accounts for <1% of all cerebrovascular accidents which were attributed to increased viscosity of blood and activation of platelet in blood vessels. Polycythemia vera (PV) increases the risk of vaso-occlusive events including CVST which may be initial unusual presentation of disease. We present a 28-year-old male patient with headache associated with nausea, vomiting, and blurring of vision. Initial clinical examination was unremarkable, and blood investigations revealed erythrocytosis and neutrophilic leukocytosis with prominent granules. Brain imaging studies were consistent of cerebral venous thrombosis with hemorrhagic transformation and perilesional edema with midline shift. He was managed by decompressive hemicraniectomy, low molecular weight heparin, central nervous system decongestants, antiepileptics, and supportive care with close monitoring. PV is a hypercoagulable state which may precipitate vascular thrombosis. CVST is rare presentation of PV. Early screening for occult prothrombotic entities with prompt management increases the patient outcome and prognosis.
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Scope and need of simulation in medical education p. 25
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
Quality-assured patient care is often looked upon as a combination of adequacy, accuracy, and promptness regardless of the settings. Simulation has been acknowledged as an important aspect of medical training as it immensely reduces the probability of errors done by a freshly passed student either in elective or emergency settings. The process of learning is encouraged through immersive learning, reflection by the students on their own performance, and through the feedback given by the teacher who is present. The inclusion of simulation in medical education helps the students to become competent in responding to real-life scenarios in an organized manner without jeopardizing the ethical or legal rights of the patients. In conclusion, the employment of simulation in medical education aids in the improvement of the professional performance of the medical students and ensures the safety of the patients. Thus, all the medical colleges should aim for its gradual introduction within their implemented curriculum and give a number of learning opportunities to the students.
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Problem based learning curriculum under institutional setting develop lifelong learners: a misnomer? p. 27
Syed Sadat Ali
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