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   Table of Contents - Current issue
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July-December 2021
Volume 23 | Issue 2
Page Nos. 113-230

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EDITORIAL  

Transition towards “end” emicity. When and how can a country possibly declare endemicity of the COVID-19 locally? p. 113
Naveen Chawla, Kiran Kumar Maramraj, Sougat Ray, C Sudeep Naidu, Sunil Goyal, Ajit Gopinath
DOI:10.4103/jmms.jmms_125_21  
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REVIEW ARTICLE Top

Acoustic radiation force impulse (ARFI) in the evaluation of liver fibrosis in chronic liver disease: Where do we stand today? p. 117
Pradipta C Hande, Vivek Hande
DOI:10.4103/jmms.jmms_2_21  
Chronic liver disease (CLD) is common in clinical practice, and the estimation of liver fibrosis (FIB) is crucial for the treatment of these patients. Liver elastography is more widely used in the evaluation of hepatic steatosis and FIB. Acoustic radiation force impulse (ARFIs) are an imaging technique which is available on ultrasonography machines to indicate tissue stiffness of various organs as it correlates with tissue elasticity. Various etiologies can cause moderate-to-severe hepatic FIB which can lead to altered liver function with structural and biochemical abnormalities which eventually result in liver failure. Commercially available ultrasound machines with incorporated ability for shear-wave (SW) technology and available software systems can perform ARFI. Usually, curved array 3.5–4 MHz transducers are used for obtaining SW velocities. We aim to review the clinical applications of ARFI as a noninvasive method using SW velocity measurements to assess the severity of liver FIB in liver parenchymal diseases. In this article, we have discussed the efficacy of quantitative assessment to evaluate the severity of liver disease which has a direct impact on the management and outcome of CLD.
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ORIGINAL ARTICLES Top

Study of blood pressure and its relationship with anthropometric variables among school children p. 124
Ilankumaran Mookkiah, Mahendra Vikram Singh, Saurbah Bobdey, Anand Neelakandan, Kiran Kumar Maramraj
DOI:10.4103/jmms.jmms_89_20  
Introduction: Hypertension is a global public health issue. Blood pressure (BP) has been shown to track (or persist) from childhood to adulthood. Obese and overweight children have a higher prevalence of elevated BP than normal weight children. Hence, the prevention of childhood obesity is one of the cardinal strategies for the prevention of hypertension and cardiovascular risks later in life. Materials and Methods: It was a cross-sectional study conducted among school children of age 10 years and above. BP and anthropometric measurements such as height and weight were measured using standard methods for 1620 children. The data were compiled and statistical analysis was done to assess the relationship between BP and anthropometric parameters. Results: A total of 990 boys and 630 girls were examined. The mean age for boys was 14 years (range 10–18 years) and mean age of girls was 13.8 years (range 10–18 years). The mean systolic BP and diastolic BP of the study participants increased uniformly with the increase in weight, height, and body mass index (BMI). A significant positive correlation was observed between anthropometric parameters and BP. Conclusion: This study reinforces the evidence of significant correlation between BP and anthropometric parameters in school children. Enhancing awareness and institution of good lifestyle habits at an early age hold the key to the prevention of lifestyles diseases in adults. Hence, school children with increased weight and BMI are to be counseled regarding their diet and they should be encouraged to undertake regular physical activity.
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A study to evaluate reduction in blood loss by topical application of tranexamic acid in burn wound surgery Highly accessed article p. 129
Amitabh Mohan, G Vishwanath, Nagamahendran Rajendran
DOI:10.4103/jmms.jmms_25_20  
Background: Blood loss and problems associated with blood transfusion in burn wound excision is a major challenge a surgeon has to face. Topical application of antifibrinolytics has been used in many surgical fields. This study was conducted to assess the reduction of blood loss in burn wound excision by topical application of tranexamic acid. Materials and Methods: This Prospective observational study was conducted in a tertiary care hospital between February 2018 and May 2019. Results: In this study, we observe that by adding 0.5% tranexamic acid to 1 in 200,000 adrenalin topical solution, blood loss can be reduced while burns excision and skin grafting. In this study, after the application of tranexamic acid, the average blood loss per unit area reduced by 36% with significant P < 0.05. Conclusions: The use of tranexamic acid is effective and safe to use for topical use in concentration of 0.5% for reduction of blood loss in burn wound excision. However, further study with larger study group, should be done to confirm the findings of this study and further authenticating the results.
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Laboratory evaluation of spinosad as a potential larvicide against immature forms of Aedes aegypti p. 135
Nikhil Sisodiya, Rina Tilak, Anmol Sharma, Arti Sarin
DOI:10.4103/jmms.jmms_125_20  
Background and Objectives: Aedes mosquito has been recognized as a global emerging threat with its potential to transmit fatal diseases of international public health importance such as dengue, chikungunya, and yellow fever. Prior attempts to manage the vector with various synthetic larvicides have resulted in emergence of resistance, thus necessitating search for a safer and effective alternative. The study was an experimental laboratory-based study to screen the recent World Health Organization (WHO)-approved insecticide spinosad for larvicidal activity and compare the efficacy of the same with other currently used larvicides, namely temephos and Bacillus thuringiensis var. israelensis (Bti). Methodology: An experimental setup was done as per the WHO Pesticide Evaluation Scheme to assess the larvicidal activity of the spinosad at varying concentrations along with a positive and negative control. A preliminary screening to assess the larvicidal property of the spinosad was undertaken with 0.5 ppm concentration as recommended by the WHO. The mortality was checked after 24 h and results were statistically analyzed and LC50 and LC90 values were calculated. Results: Spinosad brought about 100% larval mortality at the recommended dosage (0.5 ppm) as well as at a lower dosage of 0.1 ppm. The comparison with the other two commonly used larvicides, namely temephos and Bti, reveals 100% and 90% mortality, respectively, in wild Aedes larvae. Conclusion: The study concludes that spinosad is a promising larvicide that can be used in rotation with temephos against Aedes aegypti in potable water and may be used at a lower dosage of 0.1 ppm. However, large-scale field trials are required to ascertain the effectiveness of the larvicide in field conditions.
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Vitamin D status and its determinants among young unmarried adult females in Northeast India: A cross-sectional study p. 139
N Nagaraja, Barun Kumar Chakrabarty, Y Singh, M Jayalakshmi
DOI:10.4103/jmms.jmms_69_20  
Context: Undiagnosed Vitamin D deficiency is a widely prevalent problem in the Indian subcontinent. The prevalence and severity of Vitamin D deficiency are more commonly revealed among Indian females compared to males. Subjects and Methods: The study subjects comprised 198 female students of a nursing college located in Northeast India who were attending the gynecology outpatient department of a tertiary care center. Study participants were invited to respond to online queries related to Vitamin D deficiency and associated sociocultural practices. Among them, 126 students who had volunteered, 25 OH Vitamin D total levels were estimated by enzyme-linked fluorescent assay method along with linked blood parameters. Results: In this cross-sectional study, among the 198 study subjects attending outpatient services, 75.3% reported less than an hour daily exposure to the sun though 93.4% had awareness that sunlight exposure is the best natural resource of Vitamin D. All eight participants who did not have the proper knowledge of Vitamin D source were detected to be deficient. Our study showed that out of studied 126 students, half of them had severe Vitamin D deficiency (<8.1 ng/ml) and 45.2% demonstrated Vitamin D level <20 ng/ml (deficient). About 3.2%, i.e., four females, divulged Vitamin D level of 20–29 ng/ml (insufficient). Conclusions: Our study revealed relevant knowledge, belief, and sociocultural practices related to Vitamin D deficiency among young adult females of Northeast India. Contrary to previous studies, the findings also highlighted the alarmingly high prevalence of Vitamin D deficiency in the studied population.
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An analysis of length of hospital stay of COVID-19 patients admitted in a dedicated COVID-19 hospital p. 145
Aayush Maj, Saurabh Bobdey, Surinder Kumar, Rajesh Sahu, Rohit Vashisht, Vijay Bhaskar, DS Faujdar, Arun Kumar Yadav, SK Kaushik, SS Bhatia
DOI:10.4103/jmms.jmms_156_20  
Background: The ongoing coronavirus disease 2019 (COVID-19) pandemic has placed an unprecedented strain on Indian healthcare systems, with rapidly increasing demand for life-saving equipment and intensive care unit beds. The present study presents an analysis of average length of stay (LOS) as per different demographic and clinical factors in a dedicated COVID hospital. As the pandemic escalates, average LOS in COVID hospital will form the basis of determining the optimum requirement for healthcare resources (beds, staff, and equipment), which is a key priority for bolstering a strong public health response against COVID-19. Materials and Methods: Using the medical records at a dedicated COVID-19 hospital, the demographic details and select clinical characteristics of 342 admitted patients (from July 13, 2020, to August 30, 2020) were abstracted. Hospital LOS, calculated from the actual admission and discharge dates, was compared within the categories of demographic and clinical characteristics using Student's test and analysis of variance. SPSS version 20 was used for descriptive as well as inferential statistics. Results: The mean LOS was 9.93 ± 4.45 days with a range of 3–37 days. LOS increased with increasing age, with maximum being for >61 years (12.69 ± 7.14) and minimum for the younger age category of <40 years (8.88 ± 1.95) (P = 0.001). As COVID-19 severity increased, LOS increased, with longest being for severe patients (25.59 ± 7.30) and shortest being for Mild patients (8.74 ± 1.80) (P = 0.001). LOS was also longer for patients having multiple comorbidities (13.00 ± 7.96) and shortest for those with no comorbidities (9.33 ± 2.96) (P = 0.001). Conclusion: LOS is significantly affected by age, severity, and comorbidities. The actual duration and factors influencing LOS are crucial for health administrators and policymakers to better allocate the already scarce health resources.
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Role of d-dimer levels at admission in predicting outcome in coronavirus disease-2019 patients: A tertiary care center study from India p. 149
Jasdeep Singh, Jasvinder Kaur Bhatia, Sitaram Ghosh, Brajesh Singh
DOI:10.4103/jmms.jmms_171_20  
Introduction: Worldwide pandemic spread of the novel coronavirus disease-2019 (COVID-19) has led to people being afflicted by COVID-19 with an ever-rising mortality leading to 1,079,029 deaths as on October 13, 2020 (covid19.who.int). Due to the rising incidence and mortality associated with COVID 19 in India with 7,175,880 confirmed cases and 109,856 deaths reported till October 13, 2020, it was imperative to have an early and effective predictor of clinical outcome to augment the present management of COVID 19 patients. Objective: The aim of the present retrospective study was to evaluate whether elevated D-dimer levels at admission in a reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19 patients could predict the severity of disease and outcome. Methods: D-dimer levels of patients with RT-PCR confirmed COVID-19 were retrospectively evaluated for patients admitted at this tertiary care hospital in India from March 28, 2020 to June 2, 2020. D-dimer levels on admission along with the clinicopathological profile of the patients were retrieved from the records held and intensive care unit (ICU) as well as death events were collected to calculate the optimum cutoff using the receiver operating characteristic curve. The subjects were divided into two groups and D-dimer levels between uncomplicated cases and those requiring ICU admission or died during the course of disease compared to assess the predictive value of D-dimer. Results: A total of 70 patients were included in this study admitted in this tertiary care hospital whose complete D-dimer records were available and retrieved retrospectively. Ten deaths occurred during hospitalization in the study period. Patients with mean D-dimer levels ≥4026.56 μg/ml (fibrinogen equivalent units [FEU]) had a higher incidence of morbidity and mortality as compared to those who with lower mean D-dimer levels of 1268.66 μg/dl (FEU) with P < 0.001. The optimum cutoff value of D-dimer to predict in-hospital ICU admission or mortality at our hospital was 857.9 μg/L (FEU) with a sensitivity of 93.3% and a specificity of 69.09% and a negative predictive value of 97.44%. Conclusion: A D-dimer level > 857.9 μg/L (FEU) at admission portends a worse outcome for COVID-19 patients.
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Self-collected saliva: Diagnostic potential for severe acute respiratory syndrome coronavirus-2 testing in a resource-limited setting p. 155
Kavita Bala Anand, Santosh Karade, Prashant Jindamwar, Sourav Sen, Bhagya Babu, Sourabh Bobdey, RM Gupta
DOI:10.4103/jmms.jmms_198_20  
Background: The gold standard for the diagnosis of coronavirus (CoV) disease 2019 in the hospital and community setting is by the real-time reverse transcription-based polymerase chain reaction (RT-PCR) using the respiratory samples. The collection of nasopharyngeal or oropharyngeal swab (NP/OP) needs experienced medical personal and appropriate biosafety conditions. There is need for a simpler strategy for the sample collection without compromising the sensitivity. Saliva sample collection is noninvasive. Therefore, the primary objective of the study was to evaluate the efficacy of severe acute respiratory syndrome CoV-2 (SARS-CoV-2) RT-PCR using self-collected saliva specimen. Materials and Methods: This pilot study was carried out at an Indian Council of Medical Research (ICMR) approved molecular laboratory. Self-collected saliva and OP/NP swab in the viral-transported medium (VTM) were collected in parallel from the study participants and processed for SARS-CoV-2 RT-PCR. Cycle threshold (Ct) value of envelope gene (“E”), HKU Orf 1b gene (“HKU”), and Actin (internal control) obtained for saliva and NP/OP swab were tabulated. Results: Saliva and OP/NP swab in parallel were collected from 85 individuals. The mean age of the study population was 35.2 years, and 81% were male. The overall sensitivity and specificity of RT PCR on the saliva sample were 95.6% and 92.5%. The concordance between 'E” and “HKU” Ct value obtained by NP/OP and saliva RT-PCR was 97.64% and 95.29%. The positive and negative predictive value of the novel method was 93.5% and 94.9%, respectively. Conclusion: Self-collected saliva is a reliable biological sample and promising tool for SARS-CoV-2 testing in the resource-limited setting.
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Prognostic significance of absolute lymphocyte count, absolute neutrophil count, and neutrophil-to-lymphocyte ratio in COVID-19 p. 159
KV Padmaprakash, Kuldeep Kumar Ashta, Nishant Raman, Vasu Vardhan, Sandeep Thareja, J Muthukrishnan, KS Rajmohan, Sudhir Dubey, Dheeraj Nauhwaar, Abhinav Kumar, P Basavaraj
DOI:10.4103/jmms.jmms_3_21  
Introduction: Effective triage of COVID-19 patients, especially in resource-limited settings, requires cost-effective and readily available markers. The present study looks at the prognostic role of three such laboratory parameters, absolute lymphocyte count (ALC), absolute neutrophil count (ANC), and neutrophil-to-lymphocyte ratio (NLR). Methodology: A retrospective cohort study was done including 328 COVID-19 reverse transcriptase–polymerase chain reaction-confirmed hospitalized patients aged 18 and above in a tertiary center in northern India. Baseline demographic, clinical, and laboratory parameters were collected on the day of admission. Statistical analysis included descriptive statistics, sensitivity–specificity analysis for optimum cutoffs, multiple logistic regression, and Cox proportional hazards regression. Results: The median age of the patients was 45 with 266 (81.1%) males and 62 (18.9%) females. A total of 109 (33.2%) patients were affected with moderate to severe disease. Forty-nine (14.9%) patients had fatal outcomes. Median ALC was lower in patients with moderate to severe disease compared to mild disease (895 vs. 1554.2) and in nonsurvivors compared to survivors (732.0 vs. 1423.9). Median ANC (5182.8 vs. 3057.6) and NLR (5.38 vs. 2.03) were significantly raised in patients with moderate to severe disease as against mild disease and in nonsurvivors(ANC 7040.25 vs. 3448.5, NLR 10.05 vs. 2.35). ALC <1273, ANC >3907, and NLR >2.74 showed considerable sensitivity and specificity for disease severity at admission. ALC and ANC were significantly associated with the odds of moderate to severe disease at admission in the multivariable logistic regression analysis. ALC <1183, ANC >4612, and NLR >3.76 had good sensitivity and specificity as predictors of mortality and emerged as independent risk factors for mortality in the multivariable Cox proportional hazards regression. Conclusion: ALC, ANC, and NLR are relatively cost-effective and readily available routine investigations obtained as a part of complete blood count. These indices show good prognostic significance. Their utility in clinical algorithms can better guide management of patients.
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Perception of faculty and students about E-learning – its feasibility, acceptance, and implementation in COVID pandemic crisis p. 167
Pramila Menon, Vineeta Pande, Sudhir Jadhav, Sharad Agarkhedkar
DOI:10.4103/jmms.jmms_25_21  
Context: The study aimed to understand the perception of faculty and undergraduate students toward E-learning and its acceptance and feasibility during the corona pandemic. Aim: It aimed at collecting suggestions to improve the teaching–learning process. Settings and Design: This was an online survey conducted using Google Forms. Subjects and Methods: Responses were sought from participants through Google Forms and their feedback was collected using a semi-structured questionnaire which had 14 items including demographic profile, platform used for online teaching–learning, advantages, comfort level, usefulness of platform, challenges faced, and suggestions for improvement. Statistical Analysis Used: Statistical Analysis was done by using IBM SPSS Statistics for Windows, Version 26.0. Results: Responses were sought from a total of 447 (436 + 11) participants through Google Forms. Out of 447 participants, 321 responses (71%; 95% confidence interval [CI]; 67.5–75.8) were recorded and their feedback was collected using a semi-structured questionnaire which had 14 items including demographic profile, platform used for online teaching–learning, advantages, comfort level, usefulness of platform, challenges faced, and suggestions for improvement. The response rate was 71.4%% (95% CI; 67.5–75.8). About 81% (95% CI; 67.5-75.8) of participants were happy with the ongoing online teaching–learning. About 52.9% (95% CI; 47.3–58.6) are using Google Classroom, 32.2% (95% CI; 27–37.6) are using video-based platforms such as Zoom, Google Meet, and Cisco Webex. About 53.6% (95% CI; 48–59.2) of participants viewed Google Classroom as the best platform, whereas 44.1% (95% CI; 38.5–49.7) favored video-based platforms for teaching–learning. Conclusions: Online classes were found acceptable by most of the students and faculty. The positive feedback and suggestions helped in the planning of E-learning classes in the existing curriculum for future.
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Seroprevalence of SARS-COV2 antibodies among the serving personnel of south western command: A multi-centric study p. 171
Vikram Singh Grewal, Kuntal Bandyopadhyay, Ashish Jain, Rakhi Dhawan, Arunjeet Singh, Kedar Jayant Raikar, Navdeep Dahiya, Chetan Kharche, Sanjeev Satish Srivastava, Manohar Dutt, Atul Kotwal
DOI:10.4103/jmms.jmms_70_21  
Background: Serological diagnosis has become an important tool to understand the extent of COVID-19 in the community. Thus, this study was conducted to estimate the prevalence of SARS-CoV-2 antibodies and to analyze various characteristics (risk factors) associated with SARS-CoV-2 infection among serving personnel in a large geographical area straddling four North Indian states. Materials and Methods: This multicentric, cross-sectional analytical study was conducted among serving personnel in eight stations spread over Punjab, UP, Haryana, and Rajasthan in October-November 2020. A total of 3680 (410 × 8 = 3280 general participants and 50 × 8 = 400 purposive samples) individuals were enrolled and tested using IgG ELISA kit (in four stations) and RAPID CARD-based tests (in the rest four stations). Results: While the overall seroprevalence was found to be 16.57% (610/3680 participants being positive), the seropositivity was found to be 12.01% (10.92%–13.70%) and 54% (52.35%–56.45%) among the study participant's and purposive sampling groups, respectively. While statistically significant association was found between seronegativity and attending any lecture on COVID-19 before the survey (P < 0.001) or following recommended protocols for the prevention of COVID-19 (P < 0.001), a similar association was found between seropositivity and occupation with high exposure to serving personnel or civilians (P < 0.001), having close contact (less than one meter) with COVID-19 confirmed cases in the past (P < 0.001) and being tested positive for COVID-19 in the past (P < 0.05). Conclusion: Our study found a moderate overall seroprevalence with low seroprevalence in few stations and high in the rest.
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Prevaccination seroprevalence of COVID-19 immunoglobulin g antibodies in health-care personnel and general population after first pandemic wave in a himalayan region in North India p. 178
Inam Danish Khan, Ashok Kumar Jindal, Kavita Sahai, Indranil Samanta
DOI:10.4103/jmms.jmms_73_21  
Introduction: COVID-19 has been declared as Public Health Emergency of International Concern with extreme risk of sustained global spread. The pandemic is likely to evolve in successive waves until herd immunity threshold (HIT) is achieved. Asymptomatic carriers and contacts are likely to elude case reporting through conventional algorithm of case finding, testing, contact tracing, and outbreak surveillance, thereby leading to underestimation of disease burden. Widespread community-level transmission of COVID-19 renders higher risk to health-care personnel due to higher propensity and duration of multiple exposures compared to general population. Methods: This is a cross-sectional clinicoepidemiological outcome surveillance study on prevaccination seroprevalence of COVID-19 immunoglobulin G (IgG) antibodies against S1 receptor binding domain in health-care personnel and general population. Results: Seroprevalence of COVID-19 IgG in 570 health-care personnel was 224/570 (39.3%), without any skew based on age or gender. 75% were exposed in the hospital while 21.2% were exposed during travel and 3.1% through high-risk contact outside the hospital. Out of 33 COVID-19 positives, 88% underwent hospital isolation including one ICU admission and 12 home isolation. Seroprevalence of COVID-19 IgG in 400 individuals from general population samples was 138/400 (34.5%). Conclusion: Prevaccination seroprevalence of COVID-19 IgG antibodies after the first pandemic wave revealed no significant difference among health-care personnel and general population reflecting upon a possibility of consecutive pandemic waves until community attainment of HIT. Seroepidemiology can be a robust tool essential to ascertain exposure, immune response, immunity status, and predict susceptibility in population cohorts.
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Changes in the psychophysiological and cognitive parameters of the sailors wearing cooling vest while working in high ambient temperature condition of the engine room onboard a naval ship: An experimental study p. 183
Raksha Jaipurkar, SS Mohapatra, Chitra Banerjee, Saurabh Bobde, Santosh Karade
DOI:10.4103/jmms.jmms_165_20  
Background: Cooling vests are supportive garments used to overcome heat stress among individuals working in hot and humid environment. These vests were used extensively by fire-fighters and coal mine workers in past. In this study we have evaluated the effectiveness of cooling vest on psychophysiological and cognitive parameters of the sailors working in the engine room of a Naval ship. Aims and Objectives: Aim of out is to evaluate effectiveness of cooling vests in alleviating heat strain and maintain physiological parameters and behavioural alertness of sailors working in the hot and humid climate of engine room. Materials and Methods: The Physiological Strain Index (PSI), the level of Anxiety and the Psychomotor Vigilance testing was determined from 50 healthy male sailors while on 4 hrs of watch in the engine room in two different occasions i.e. once wearing the cooling vest and once more without wearing it. Subjective perception of acceptability of cooling vest was assessed by a self-made questionnaire. Results: The mean body temperature (Aural), pulse rate, respiration rate along with the Physiological Strain Index (PSI) was significantly lower both during mid watch as well as at the end watch among the engine room sailors while performing the watch wearing the cooling vest (Watch-2) in comparison to the watch without wearing it (Watch-1). The mean change in reaction time in the Psychomotor Vigilance Testing (PVT) was lesser while performing the watch with cooling vest (Watch-2) than the watch without it (Watch-1). Similarly, a higher proportion of participants had shown to have no increase in their anxiety level (Hamilton Anxiety Score) at the end of the watch when performing it with cooling vest. Also, the positive acceptance for the cooling vest was also observed among larger portion of participants. Conclusion: The study indicated lesser heat strain, lesser deterioration of Psychomotor vigilance function, lesser proportion of participants showing anxiety among the sailors wearing cooling vest while working in the hot and humid condition of engine room of a naval ship. A positive acceptance for cooling vest was also observed among higher number of these participants.
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Gaseous pollutants in Indian EKM and SSK class submarines p. 191
Vivek Verma, Nimesh Tarway, Anil Pinninti
DOI:10.4103/jmms.jmms_61_19  
Introduction: Once a submarine dives, the captive atmosphere inside keeps changing due to release of various pollutant gases. The gases are produced by machinery, cooking, human, paints, batteries, cooking etc. The study was envisaged to measure these gaseous pollutants on surface and in prolonged dive onboard EKM and SSK class submarines. Methods and Material: Detector tubes and pumps were used to measure the concentration of twenty gaseous pollutants in harbour on surface & during sailing in dived condition. In harbour, readings were taken early morning and before secure in the evening. During sailing readings were taken on surface, just after diving and thereafter every four hrs. The readings were recorded in excel sheet and correlated with activities on board at time of taking reading. Results: Only Ammonia and Hydrogen Sulphide were detected at the beginning of the day in harbour, however by the end of the day all other gases were detected except Mercury, Oil mist, Nitrogen Dioxide, Ozone & Arsine. At Sea none of the gases were detected at the beginning of sailing. At 12h post dive all gases were detected except Mercury, Oil mist, Nitrogen Dioxide, Ozone, Halogenated Hydrocarbons & Arsine. Recommendations and Conclusion: The gas concentration values obtained by using detector tubes and pumps were found to be within recommended Permitted Exposure Levels (PEL) for human for continuous exposure. No gas was found to be above the recommended PEL. There was no significant difference in the gas concentration levels in the EKM & SSK Class submarines. Pump and detector tube is a convenient, reasonably accurate and efficient method to measure gaseous pollutants on board Submarines.
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Efficacy of ultrapulse carbon dioxide laser ablation versus 30% trichloroacetic acid in xanthelasma palpebrarum - A randomised controlled trial p. 196
Niyor Mukuta Das, Radhakrishnan Subramaniyan, Sandeep Arora, Rajeshwari Dabas, Manasa Shettisara Janney, Sandeep V Lal
DOI:10.4103/jmms.jmms_80_20  
Context: Xanthelasma palpebrarum (XP) is the most common cutaneous xanthoma that develops around the eyes. A number of treatment modalities have been tried for its removal, but none are truly satisfactory. Trichloroacetic acid (TCA) is commonly used in Indian setting as it is easily available and cost-effective whereas carbon dioxide (CO2) laser has been tried increasingly due to its favorable cosmetic outcome. Aims: This study aims to compare the efficacy of ultrapulse CO2 laser ablation with 30% TCA in the treatment of XP. Setting and Design: Prospective, interventional, randomized study at a Dermatology Centre of a Tertiary Level Hospital from January 2017 to June 2018. Methods: Seventy-four patients with 100 lesions of XP were divided into two groups of flat and elevated lesions. Each group was further randomly divided into two subgroups and administered CO2 laser once a month and 30% TCA once in 2 weeks respectively for 3 months. Patients were clinically assessed at baseline and then at monthly intervals using visual analog scale (VAS), patient satisfaction score (PSS), and standardized photographs. The follow-up was done at the end of 3 and 6 months. Statistical Analysis and Results: Mean PSS and VAS score of TCA and laser in flat and elevated lesions were compared using independent group Student's t-test. Response to laser in elevated lesions was found to be statistically better whereas in flat lesions the response to TCA and laser were similar. Recurrence was 17% and 6% at 3 months' follow-up and 24% and 11% at 6 months' follow-up in TCA and laser groups, respectively. Conclusions: The end results of ultrapulse CO2 laser and 30% TCA are comparable in flat lesions of XP. In elevated lesions, laser has better efficacy, requires fewer sittings with lesser chance of recurrence.
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Speed versus sensitivity: Performance of SARS-CoV-2 rapid antigen test in the hospital setting p. 201
Apoorva Sharma, Santosh Karade, Kavita Bala Anand, Mahima Lall, Sourav Sen, Seema Patrikar, Nardeep Naithani
DOI:10.4103/jmms.jmms_29_21  
Background: As the world battles the coronavirus disease 2019 (COVID-19) pandemic, rapid detection is the key to contain the spread of the disease. Although real-time polymerase chain reaction (RT-PCR) remains the gold standard for the diagnosis of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection, it demands specialized equipment and technical expertise. SARS-CoV-2 rapid antigen detection test (RAT) is the user-friendly alternative, which needs evaluation in the hospital setting. Materials and Methods: This cross-sectional study was carried out at the Indian Council of Medical Research approved COVID-19 diagnostic molecular laboratory between November and December 2020. Nasopharyngeal swabs in viral transport medium (VTM) were received from suspected SARS-CoV-2 infected individuals were processed for SARS-CoV-2 RT-PCR and a rapid antigen detection test, COVID-19 Ag Respi-Strip. Results: A total of 342 samples were assessed for this study by RT-PCR and Rapid Antigen Test. The sensitivity of RAT was found to be 41% at an RT-PCR cycle threshold of 35 or below. Sensitivity of RAT improved to 81.2% when a RT-PCR cycle threshold of 25 or below was considered as positive. Specificity of RAT was 99% to 100%. Conclusion: Rapid antigen test is a cost-effective alternative for screening of symptomatic individuals in the hospital setting. However, due to low sensitivity, the negative results need to be interpreted with caution.
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PERSPECTIVE Top

Future of the coronavirus disease-2019 pandemic: An evidence-based insight p. 205
Sougat Ray, C Sudeep Naidu, Kiran Kumar Maramraj, Naveen Chawla, Shruti Vashisht, Kaushik Roy, A Gopinath
DOI:10.4103/jmms.jmms_122_21  
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Coronavirus disease 2019 - A pediatrician's perspective p. 208
Bal Mukund, Vivek Bhat, Ashutosh Kumar
DOI:10.4103/jmms.jmms_127_21  
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CASE REPORTS Top

Adverse hemodynamic response due to malposition of central venous catheter p. 210
Shaikh Azimuddin Najmuddin, Sameer Taneja, Sachin N Kulkarni
DOI:10.4103/jmms.jmms_66_19  
Central venous catheter (CVC) is an inescapable requirement of any cardiac surgery for administering drugs including inotropes, cardiac pacing, and invasive monitoring during the perioperative period. Central venous access involves triple-lumen catheter inserted in the internal jugular or femoral vein. The preferred vein for CVCs is the right internal jugular vein because of straighter course to the right heart, better visibility on ultrasonography, lowest risk of the venous stenosis and thrombosis, and also keeping in mind the nature of surgery involved and patient positioning. Malposition of the catheter is a relatively common complication (5.01%) which results in the malfunction of catheters. We report a case of a malposition of a CVC in a 70-year-old male who underwent mitral and aortic valve replacement along with coronary artery grafting for the posterior descending artery on cardiopulmonary bypass.
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Congenital infiltrating lipomatosis of the face p. 213
Dhiraj Kumar Jaiswal, Saurabh Maheshwari, Vivek Khandelwal, Uddandam Rajesh
DOI:10.4103/jmms.jmms_128_20  
Congenital infiltrating lipomatosis of the face (CLIF) is a rare condition that is included in the subgroup of lipomatous tumor-like lesions. We present a rare case of CLIF in a 19-year-old male with clinical, imaging, and histopathological findings along with a review of the relevant literature. Our patient had a gradually progressive swelling on the left half of the face since childhood. Radiograph, computed tomography scan, and magnetic resonance imaging showed heterogeneous ill-defined fat-density lesion involving the left half of the face. Histopathological examination confirmed the diagnosis of CLIF. This diagnosis should be suspected on clinical examination and can be confirmed based on characteristic radiological findings. The patient should be kept under regular observation until the stabilization of bone growth, after which appropriate cosmetic surgery should be performed.
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Magnetic resonance imaging findings in a rare case of left ventricular noncompaction p. 216
RA George, Anil Kumar, Navreet Singh, Sangeet Kumar
DOI:10.4103/jmms.jmms_53_20  
Left ventricular noncompaction (LVNC) is a relatively rare clinical entity with a grave outcome. Various morphological findings, both on two-dimensional echocardiography and cardiac magnetic resonance imaging (MRI), have been depicted in the literature, helping in establishing the correct diagnosis of this condition. We describe a rare case of LVNC and its MRI features.
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CASE SERIES Top

Risk factor profile of Mucormycosis in COVID 19 patients: A Case series p. 219
Rahul Soni, Dheeraj Nauhwaar, Abhinav Kumar, Ankita Patil, Manish Saha, Jayita Debnath
DOI:10.4103/jmms.jmms_97_21  
Coronavirus disease-19 (COVID-19)-infected patients are at risk to develop severe opportunistic infections, especially fungal infections. The incidence of mucormycosis has increased in patients who are recovering from COVID-19 and now it has become an epidemic in India. In the background of the COVID-19 pandemic, we present a case series of seven patients with mucormycosis and their risk factor profile. Six of our patients had nonketotic poorly controlled glycemic status. All patients were mild or asymptomatic as far as COVID-19 clinical symptoms are concerned, but they had high inflammatory markers such as interleukin 6 (IL-6), ferritin, and D-dimer, which are commonly seen in a cytokine storm. Hyperglycemia and COVID-19 infection were consistent features in our patients. We found that COVID-19 patients with poor glycemic control and high inflammatory markers are at high risk for mucormycosis infection. However, the duration from the diagnosis of COVID-19 and the development of symptoms of mucormycosis was varied from 1 to 12 days (mean- 5.71). There was no correlation of the level of IL-6 or D-dimer with the early onset of mucormycosis. We also did not find any correlation of mucormycosis with other proposed risk factors such as oxygen therapy, steam inhalation, or prolonged steroid therapy, since four of our patients had never received steroids in any form and three had received only mild dosages of steroid. The sample size for statistical analysis was inadequate. However, a randomized clinical trial or larger observational study is needed to establish this observation.
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COMMENTARY Top

Oxygen therapy: How much is too much p. 225
Nikahat Jahan, Rangraj Setlur
DOI:10.4103/jmms.jmms_123_21  
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CORRESPONDENCE Top

COVID-19 vaccine in Indian children: A debatable issue!! p. 228
Vishal Mangal, Kaminder Bir Kaur
DOI:10.4103/jmms.jmms_104_21  
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