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   Table of Contents - Current issue
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January-June 2022
Volume 24 | Issue 1
Page Nos. 1-108

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EDITORIALS  

Role modeling: A powerful tool to imbibe professionalism in medical practice p. 1
Naveen Chawla, Anuj Singhal, Subhash Chandra Shaw
DOI:10.4103/jmms.jmms_28_22  
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Publication ethics: Notes for authors and editors p. 4
Arun Kumar Yadav, Laxmikant Chaudhary, Anuj Singhal
DOI:10.4103/jmms.jmms_21_22  
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ORIGINAL ARTICLES Top

Online teaching of undergraduate and postgraduate medical students in pediatrics: Single-center experience p. 7
Apoorv Saxena, Subhash Chandra Shaw, Biju M John, KM Adhikari
DOI:10.4103/jmms.jmms_68_21  
Background: The COVID-19 pandemic has forced the world to change its approach to medical education with most of the undergraduate (UG) teaching shifting to online mode. As in other colleges in India, we also switched to online classes for both UG and postgraduate (PG) students in April 2020. We intend to share our preliminary experience about the acceptance and performance of these online classes in Pediatrics. Methodology: For UGs, we studied the attendance and marks of term ending summative assessment of batch of 2020 who attended online classes and compared them to the attendance and marks of the term ending summative assessment of the previous three batches (2017, 2018, and 2019). We also obtained a feedback on a prevalidated questionnaire from the UG as well as PG students. Results: The mean ± standard deviation (SD) attendance of the batch of 2020 was 81.6 ± 16.2%, while that of the 2017, 2018, and 2019 batch during the same period was 84.9 ± 10.9%, 92.6 ± 4.8%, and 83.0 ± 7.6% respectively. Similarly, the mean ± SD marks for the batch of 2020 was 74.8 ± 6.5% while it was 66.9 ± 9.4%, 58.6 ± 10.1%, and 60.9 ± 9.7% for 2017, 2018, and 2019 batches, respectively. The feedback obtained from both UGs and PGs was satisfactory in relation to the acceptance of the online mode. Conclusion: The online classes in Pediatrics are a reasonable alternative to the onsite classes in the prevailing situation.
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Role of point-of-care ultrasound in grading the severity and early diagnosis of high-altitude pulmonary edema at a peripheral hospital p. 11
Saurabh Sud, Yogesh Kumar, Saurabh Bharadwaj, Deepak Dwivedi, Arun Kumar, Archit Garg
DOI:10.4103/jmms.jmms_138_20  
Background and Aims: Troops deployed at high-altitude area (HAA) suffer from various high-altitude illnesses (HAIs) including high-altitude pulmonary edema (HAPE). There are various criteria to diagnose and assess the severity of HAPE, but point-of-care ultrasound (POCUS) of the lung has also been used in isolation by physicians. The aim is to assess whether POCUS of the lung improves the ability to diagnose the severity of HAPE. Methodology: A retrospective, cross-sectional descriptive study was planned for the patients treated for HAPE (n = 46) at our hospital from January 2019 to March 2020. Prehospital admission data, hospital admission data, and discharge data for the first-time inductees and reinductees were collected from the central hospital admission registry and central database of the medical department and intensive care unit. Results: The incidence of HAPE was 2.2 per 1000. First-time inductees (n = 30) were affected more when compared to reinductees (n = 16) and the maximum were at the third stage of HAA. POCUS of the lung facilitated the diagnosis of the six patients with mild HAPE with no positive radiological features. Conclusions: POCUS of the lung should be routinely used by the medical officers deployed at high altitudes. It will increase the diagnostic rate of HAPE with meticulous grading of the severity, thereby aiding in formulating the case-specific treatment protocol.
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Echocardiographic manifestations in patients on renal replacement therapy and renal transplant recipients p. 17
PL Vidya, Satish Chandra Mishra, Ananthakrishnan Ramamoorthy, Arijit Kumar Ghosh, Priyanka Singh, Ishan Sharma, Nitin Bajaj
DOI:10.4103/jmms.jmms_4_21  
Background: Chronic kidney disease (CKD) patients have 20–30 times greater risk of cardiovascular morbidity and mortality. Echocardiography is quintessential in cardiovascular evaluation and monitoring in CKD patients. This study was designed to determine the echocardiographic manifestations in patients on renal replacement therapy (RRT) and recipients of renal transplantation. Materials and Methods: An observational cross-sectional study was undertaken in a tertiary care hospital. All CKD patients on RRT or post renal transplant were included. Patients with known cardiac disease, malignancy were excluded. Demographic details, thorough history, physical examination and 2D echocardiography were performed for the patients. Results: Of the 51 patients, 60% were on dialysis and remaining were post renal transplant recipients. The mean age of study population was 44.16±13.66 years, with 64.7% males. 47% of patients were of age group of 41 years to 60 years. The most common etiology of CKD was hypertension in 16 (31.4%) followed by diabetes in 11 (21.6%). Only 8 patients (15.7%) had normal echocardiograms. LVH (80.4%) was most common abnormality, followed by diastolic dysfunction (74.5%), systolic dysfunction (13.7%), mitral regurgitation (13.7%) and pericardial effusion (5.8%). Around 95.2% had concentric hypertrophy. Diastolic dysfunction was observed in 90.2% and 80.9% of cases with LVH and hypertension respectively and was significantly associated with both (p=0.001, p=0.003 respectively). Conclusions: Left ventricular hypertrophy was the most common abnormality in CKD patients and renal transplant recipients. Diastolic function was affected in majority of patients. Early identification of cardiac abnormalities by echocardiography prior to manifestation of cardiac complications may result in better prognosis for this patient population.
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Tympanoplasty in high-risk perforation and atelectatic ear using perichondrium-cartilage island graft and temporalis fascia: A comparative analysis p. 24
Tarun Malhotra, Shymal Jha, Deep Kamal, Vaidehi Thakur
DOI:10.4103/jmms.jmms_41_21  
Background: The prevalence of chronic otitis media in the Armed Forces is high. Moreover, management of high-risk perforation and atelectatic ear is an even greater challenge. It is necessary to assess the most viable management approach to achieve an optimal outcome. Aims and Objectives: We aimed to compare anatomical and audiological results in tympanoplasty for high-risk perforation and atelectasis using perichondrium-cartilage island (PCI) graft with temporalis fascia (TF) graft. Materials and Methods: A retrospective study was carried on 110 patients. Fifty-four patients and 56 patients underwent PCI graft and TF tympanoplasty, respectively. Postoperative graft integration rates and hearing outcomes were compared. Chi-square test was carried out to compare postoperative graft uptake. Postoperative audiological outcomes were compared using t-tests. Results: At 2-year follow-up, the graft take-up rate for PCI graft and TF graft was 96.29% and 82.14%, respectively (statistically significant). In the TF group, 17.86% had reperforation and recurrence of retraction pockets. In the PCI group, 3.71% had recurrent perforation. Furthermore, there was a statistically significant in the postoperative long-term improvement in pure-tone average air-bone gap in the cartilage island graft group (15.01 ± 3.53 db vs. 21.96 ± 4.09 db, P < 0.05). Conclusion: PCI graft achieves better morphological and audiological results in comparison to TF graft in high-risk perforation and atelectatic ears. It has a higher graft integration rate and better long-term audiological outcomes.
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Clinicoepidemiological profile of COVID-19-positive migrant population and their outcomes: A multicentric, retrospective study from Northeast India p. 30
Joydeep Ghosh, Amit Kumar Das, Manasa Shettisara Janney
DOI:10.4103/jmms.jmms_42_21  
Introduction: Emergence of a novel coronavirus disease (COVID 19) and its subsequent spread to India lead to declaration of lockdown by the government in various phases to reduce the transmission of COVID 19. Northeastern India being relatively remote had its first case relatively late. Later, with incoming migrant population, there was a surge in cases. This study aims to determine the clinicoepidemiological characteristics and outcomes in COVID 19 positive migrant population treated at multiple centers in Northeast India. Methods: This is a retrospective, cross-sectional,multicentric study. Data were collected from case sheets of 198 COVID-19 positive patients treated at designated COVID-19 hospitals in Northeast India. Results: Independent t-test and Fisher's exact test were used. P<0.05 was considered statistically significant. Majority of the study population were between 31 and 50 years (62.1%) with overall male preponderance (94.9%). Nearly one third (31.8%) of the study population gave a history of contact. Fever was seen 92.4% of patients. Majority (97.0%) of the study population had mild to moderate disease and only 3.0% were severely diseased/critically ill. 30%, 7%, and 3% of the study population received oxygen support, noninvasive ventilation, and ventilator support, respectively. Only 1.5% of the study population had complications of acute respiratory distress syndrome, shock, and sepsis, and the mortality rate was 1.1%. The average duration of hospitalization was 14.17 ± 5.48 days, and the average time taken to become COVID negative by reverse transcription polymerase chain reaction was 37.93 ± 7.54 days. Conclusion: A large number of COVID-positive patients had mild-to-moderate course of disease. Fever was the most common symptom. Around one-third of patients required respiratory support. Rate of complications and mortality were low in the study population. Presence of comorbidities, "O" blood group, abnormal X ray findings, elevated levels of C reactive protein, D dimer, and erythrocyte sedimentation rate had a significant positive association with severity.
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Uncommon diagnostic pitfalls of mucoepidermoid carcinoma on cytology: A tertiary care center, retrospective descriptive study p. 37
Divya Shelly, PS Mishra, Prachi Nichat, AK Das, Pratibha Chandra
DOI:10.4103/jmms.jmms_43_21  
Introduction: Diagnosis of mucoepidermoid carcinoma (MEC) on fine-needle aspiration cytology (FNAC) is grim with important diagnostic pitfalls, leading to wrong treatment decisions. This study highlights uncommon mimics of MEC on FNAC smears of major salivary glands and compares the cytologic findings with definitive histopathology diagnosis for identification of potential diagnostic pitfalls. Methods: This is a retrospective descriptive study of MEC cases diagnosed over a duration of 5 years (April 2015–April 2020) at a tertiary care center with available preoperative FNAC and postoperative histopathology resection specimens. Results: Out of a total of 18 MEC cases diagnosed by histopathologic examination, 8 (44%) were wrongly diagnosed on preoperative FNAC as a different benign or malignant entity. Further details of these cases are shared in the text. Discussion: Although FNAC remains an important preoperative diagnostic tool in salivary gland lesions, utmost care is required in the cases of MEC which are notorious for misinterpretation on cytology. A number of uncommon mimics, both benign and malignant, need to be considered and carefully excluded to spare the patient of avoidable miseries of misdiagnosis. Conclusion: MECs of salivary glands can mimic the morphology of a variety of benign as well as malignant lesions on cytology with low cyto-histologic concordance especially in cystic lesions.
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Randomized controlled trial to compare injection ferric carboxymaltose and oral iron in reducing postpartum anemia: A multicenter, pilot study p. 42
Sushil Chawla, Manoj Kumar Tangri, Ajai K Srivastava, Davinder Bhardwaj, Indu , Rajesh Mishra
DOI:10.4103/jmms.jmms_157_20  
Introduction: Iron-deficiency anemia (IDA) in pregnancy is common due to the increase demand for iron during pregnancy and is aggravated by blood loss associated with delivery. Intravenous iron formulations offer an alternative approach in the presence of moderate and severe anemia, due to intolerance of or nonadherence to oral iron and malabsorption status, to correct and prevent IDA. Ferric carboxymaltose (FCM) is a newer dextran-free iron formulation which allows for single and higher dose (up to 1000 mg) of IV iron infusion, making it a potentially ideal candidate for the treatment of postpartum anemia (PPA). Materials and Methods: A randomized control trial was conducted at two tertiary care centers involving 800 women (400 women in oral iron group and 400 women in the injection FCM group) to compare the efficacy of each in protecting the women from anemia in the postpartum period. Results: The compliance was 100% in the FCM group as the injection was given before the patient was sent on discharge after delivery. The mean rise in the hemoglobin levels in the FCM group and oral iron group was 3.76 g% and 2.476 g%, respectively. The mean rise in the serum ferritin levels in the FCM group was 214.265 mg% as noted at the end of 6 weeks. Conclusion : Injection FCM in the dose of 1000 mg given in a single dose before discharge in postpartum women helps in reducing PPA without any significant adverse effects.
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Patterns of antibody response, adverse effects, and knowledge regarding COVID-19 vaccine: Findings of a serosurvey among vaccinated individuals in North-Western India p. 47
Kuntal Bandyopadhyay, Lakshmi Geetha Nair, Deepshikha Mishra, S Shashivadhanan
DOI:10.4103/jmms.jmms_88_21  
Background: With reference to the National vaccination drive against COVID-19 disease (rolled out on January 16, 2021 by Government of India), this study was undertaken to analyze the patterns of antibody response among fully vaccinated adult individuals, to find the spectrum of adverse events following immunizations and knowledge component of the participants regarding the COVID-19 vaccines as well as its side effects. Materials and Methods: A total of 500 vaccinated individuals (with two doses of Government approved Covishield vaccine) were studied over a period of 9 weeks following the second dose of their vaccine. They were tested for the development of antibodies against SARS-CoV-2 spike protein, using an immunoglobulin G ELISA kit on three occasions, and the seroconversion pattern was analyzed. Results: A postvaccination seroconversion rate of 63.8% (at 2–3 weeks), 83.2% (at 4–5 weeks), and 93.2% (overall seroconversion rate at 8–9 weeks) was found. While 77.4% participants (at 4 weeks) and 65.9% participants (at 8 weeks) showed rise in optical density (OD) values, 7.4% showed a declining in OD values (at 8 weeks) and 6.8% remained seronegative throughout the study period. Sixty-two percent had experienced at least one form of adverse effect postvaccination, which were mostly mild in nature not requiring hospitalization. Conclusion: This study found that the timeline for seroconversion postvaccination by COVISHIELD varies between individuals, with few showing decline in the OD values as well and that majority of the adverse reactions observed in this population were only mild and manageable not requiring hospitalization.
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Teaching ethics to medical faculties: An E-learning intervention p. 53
Manushi Srivastava, Sandeep Shrivastava, Pradyumn Srivastava, Ratan K Srivastava, Shweta Jaiswal
DOI:10.4103/jmms.jmms_134_20  
Introduction: Ethics is defined as a system of moral principles or standards governing conduct; a system of principles by which human actions and proposals may be judged good or bad, right, or wrong. However, ethics for medical teachers with respect to their students has been largely unnoted. Therefore, it seems necessary to know the status of teaching ethics practiced by medical educators which are the major assets in good quality medical education. Objectives: The objectives were to study the changes in the understanding and practices of teaching ethics and principles of medical professionals. Methodology: A prospective interventional study had conducted with 30 medical faculties. Results: Only one-third of the medical educators (33.33%) had reported that they have ever read any literature in “Teaching Ethics,” but after e-intervention, this purport increased to 90.48% as indicated by the posttest results. Conclusion: It could be concluded that faculties were quite aware of the basic philosophy of teaching ethics, but they also agreed with the fact that still, medical teaching is not up to the mark as per the norms of teaching ethics, although most of them were not in agreement of those unethical teaching practices.
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Perceived stress and quality of sleep among health-care staff working in a dedicated COVID hospital p. 57
Ravi Devarakonda, Niharika Nagari, Saurabh Bobdey, Arun K Yadav, Surinder Kumar, Vivek Anand, SK Kaushik
DOI:10.4103/jmms.jmms_27_21  
Introduction: Right from the onset of the COVID-19 pandemic, health-care workers (HCWs) have been at the forefront in combating this deadly disease. The sudden emergence of COVID-19 and its continued persistence, has led to an unprecedented psychological stress among HCWs. To assess the level of stress and its effects on sleep quality of HCWs caring for COVID-19 patients, the present study was conducted among staff working in a dedicated COVID hospital. Methodology: The cross-sectional study was conducted among HCWs at a dedicated COVID hospital in northern India from September to October 20. To assess the levels of stress and quality of sleep, the participants were administered the Perceived Stress Scale and Pittsburgh Sleep Quality Index (PSQI). Results: One hundred and forty-two HCWs out of 162 responded completely. The mean age of the participants was 31.6 ± 6 years. Ninety-one (64.1%) were doctors and the rest 51 (35.1%) were paramedical staff. The mean PSQI global score was 6.9 ± 3.19. More than 50% of participants across all age categories reported moderate-to-high stress and poor sleep quality. Conclusion: This study shows that a high proportion of HCWs working in dedicated COVID hospitals suffer from stress and its varied deleterious effect, especially on sleep. Therefore, it is prudent for all stakeholders and decision-makers to take adequate steps for provision of psychological support for stress mitigation and implement measures for prevention and early identification of stress-related symptoms among HCWs working in COVID hospitals.
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A young clinician's perspective on deprescribing in elderly patients: A pilot study Highly accessed article p. 62
Vivek Aggarwal, S Shankar, Suryakant , Manish Manrai, Vivek Vasdev, Anuj Singhal, AK Yadav
DOI:10.4103/jmms.jmms_38_20  
Background: Young doctors have various barriers and hesitations towards de-prescribing. This study was planned to assess Young Clinician's perspective on deprescribing in elderly population from India. Methodology: Observation cross-sectional study done in a tertiary care hospital of Western Maharashtra. A web link consisting of 12 survey questions was shared on smart phones of postgraduates working in clinical specialties. Attitudes, knowledge, barriers and approach towards deprescribing were assessed. Results: Out of 64 doctors 30 doctors responded and completed the survey. Mean age was 32.6 years. Most common cause for deprescribing was to reduce the adverse drug reactions (76.33%), lack of definite indication (63.33%). Most common drug to be de-prescribed were multivitamins (70.66%), benzodiazepines (46.66%) and antiplatelets (43.33%). The most common barrier for de-prescribing was altering the prescription of another doctor (56.66%), lack of time and concerns on the adverse effect (36.66%). Ninety percent of the doctors were not aware of any deprescribing criteria and 70% did not have any specific approach. Conclusion: Deprescribing of drugs is a very important concept, which needs to be included in training the undergraduate medical students, postgraduate medical students and Pharmacy students.
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A study of retinal nerve fiber layer thickness and other optic nerve head parameters in cases of amblyopia p. 67
Sanjay Kumar Dhar, Kurumkatil Raji, Vijay Kumar Sharma, Prakhar Kumar Singh
DOI:10.4103/jmms.jmms_98_20  
Introduction: Amblyopia is a disorder of decreased visual acuity and contrast sensitivity, studies in past have shown retinal changes in amblyopic eyes, which was refuted by other studies. Studies in the recent past have reported variable results on retinal nerve fiber layer (RNFL) thickness in amblyopic eyes. Therefore, there is still a gap in present knowledge. This study was conducted to study RNFL thickness and other optic nerve head (ONH) parameters in amblyopic and better fellow eyes. Materials and Methods: A total of 30 diagnosed cases of amblyopia (four cases of meridional, 11 cases of anisometropic, three cases of strabismic, eight cases of ammetropic, and four cases of form deprivation amblyopia) were divided into two groups: Group A (amblyopic eyes – 30 eyes) and Group B (better fellow eyes – 30 eyes). All the eyes underwent visual acuity assessment, refraction (under cycloplegia), anterior segment evaluation, and fundus evaluation. All the patients underwent ONH evaluation by Cirrus 500 spectral-domain high-definition optical coherence tomography, before and after occlusion therapy. The ONH parameters studied were average RNFL thickness, rim area, disc area, and cup volume. The data were analyzed using SPSS version 25:00. Results: The RNFL thickness was less in amblyopic eyes as compared to normal fellow eyes, (P = 0.002). There was a positive correlation between RNFL thickness and rim area in both the groups, but it was significant (P = 0.02) in Group A only. No statistically significant difference was found between the rim area, disc area, and cup volume between the two groups. Conclusion: The RNFL thickness was found to be significantly less in amblyopic eyes, also there was a significant positive correlation between RNFL thickness and rim area in Group A (P = 0.02).
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Pure peripheral spondyloarthritis, is it exceedingly rare? A real-world experience from an Indian tertiary care hospital p. 71
Arun Hegde, Vishal Mangal, Vivek Vasdev, Kavita Singh, Kovilapu Uday Bhanu
DOI:10.4103/jmms.jmms_117_20  
Background: Peripheral spondyloarthritis (pSpA) is usually associated with psoriasis, inflammatory bowel disease, or preceding infection (called reactive arthritis). Pure pSpA is a clinical entity wherein there are enthesitis, dactylitis, or arthritis, without any of the above-associated conditions. We aimed to describe the clinical, laboratory, radiological, and management profile of pure pSpA, among patients with pSpA presenting to the rheumatology outpatient department. Materials and Methods: In this retrospective, observational study, medical records of all the patients diagnosed as pSpA by a rheumatologist, between January 1, 2016, and December 31, 2018, were included. Among these, thirty patients qualified to be called pure pSpA, and we reported their demographic characteristics (age and sex), clinical features (onset of disease, clinical signs, and symptoms), laboratory parameters (erythrocyte sedimentation rate, hemoglobin, and C-reactive protein), radiological findings, and treatment pattern. Results: Thirty patients fulfilled the criteria for pure pSpA. The mean age (standard deviation) of the patients at onset was 32 ± 5.8 years. The mean disease duration before diagnosis was 9.7 months. Arthritis, enthesitis, and dactylitis were present in 29 (96.7%), 8 (26.7%), and 9 (30%) patients, respectively. Eighteen (60%) patients had monoarthritis, while 11/30 (36.7%) had oligoarthritis, at presentation. HLA B27 was positive in 24/30 (80%) patients. Seven patients (23.3%) had bilateral sacroiliitis on imaging and two (6.7%) had unilateral sacroiliitis. Twenty patients (66.7%) required conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), while two (6.7%) required biological DMARDs in the form of anti-tumor necrosis factor-alpha inhibitors. Conclusion: Pure pSpA is a relatively rare clinical disease which presents with either a mono or oligoarthritis and shows good treatment response to csDMARDs.
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The changing paradigm of injuries and their outcome in an international conflict zone p. 76
Pawan Sharma, Abhishek Sharma, KR Rao
DOI:10.4103/jmms.jmms_44_19  
Background: The characteristics of combat injuries differ from those encountered in civilian practice in terms of epidemiology, mechanism of wounding, pathophysiology, trajectory after injury and outcome. Furthermore, the nature of combat injuries is likely to change because of changes in the ways wars will be fought; such changes may influence therapeutic tactics and techniques, and military medical planning and logistics. Proper medical deployment at various peacekeeping missions requires projecting injuries. For this reason, the injury patterns and mechanism of injury were reviewed over a five year period, and injury rates and mechanisms were extracted for review. Methods: An observational study of 2942 trauma cases attending trauma Out Patient Department and emergency centre of United Nations Peacekeeping Mission Hospital in eastern DRC (Democratic Republic of Congo), was carried out from Jan 2009 to Dec 2013. The study includes age profile of patients along with the distribution and mechanism of injuries. Results: Penetrating injuries and blunt injuries accounted for 4.65% and 95.35% respectively of the total injuries sustained. The majority of the patients sustained injuries like mixed burns and inhalation injuries, assaults and contusions (84.33%). The most common age group affected was 22- 29 years (60.74%). Conclusions: The data clearly demonstrate that humanitarian and peacekeeping missions require preparation for a wide variety of mechanisms of injuries including non-combat trauma beyond the expected penetrating missile and blast injuries of a typical war scenario.
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Knowledge, attitude and practice study on dog bite and its management among population in a rural community of Western Maharashtra p. 80
Saurabh Mahajan, Surinder Kumar, Arun Kumar Yadav
DOI:10.4103/jmms.jmms_33_20  
Background: Awareness of dog bite-related rabies in rural population of developing countries, including India, can lead to reduction in mortality from dog bite. The present study was conducted to know the general awareness pertaining to dog bite and rabies, antirabies vaccines, and health services utilization in a rural community. Also, to ascertain the first-aid measures adopted after dog bite and to know the opinion regarding control of dog population. Methods: The study was conducted as a community-based cross-sectional study in the rural field practice area of a Medical College in Western Maharashtra among the age group of 30–40 years using pretested questionnaire. Results: A total of 108 respondents participated in the study. Of the study participants, 37 (34.3%, 95% confidence interval [CI]: 25.3%–44%) participant were aware of rabies. Only 19 (17.59%, 95% CI: 11%–26.1%) participants were aware of the symptoms of rabies. Only 20 (18.5%, 95% CI: 11.7%–27.1%) participants would like to apply first-aid measure and 85 (78.7%, 95% CI: 69.8%–86%) participants will visit to doctor, and rest responded as doing nothing. Of the participants, 66 (61.11%, 95% CI: 51.3%–70.3%) were aware of antirabies vaccine and 77 (71.1%, 95% CI: 61.8%–79.6%) responded that dogs should be caught and taken away from locality, whereas the rest responded that dogs should be sterilized as a control measure. Conclusions: The gaps in knowledge, attitude, and practice with respect to prevention and control of rabies need to be addressed by educating the rural population. The present study reflects the need for making the rural population aware about the disease, vaccination, and first aid.
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Microneedle-assisted steroid delivery therapy in the management of hypertrophic scars: A split-lesion study Highly accessed article p. 84
Guruswamy Vishwanath, Jandhyala Sridhar
DOI:10.4103/jmms.jmms_108_20  
Introduction: Microneedle assisted transdermal delivery is an emerging technique of drug delivery on the horizon with exciting potential therapeutic applications. Aims and Objectives: To study the role of microneedling assisted steroid therapy in the management of hypertrophic scars and make suitable recommendations on employability of the procedure as a treatment modality. Materials and Methods: Twenty six consecutive patients with hypertrophic burn scars were studied. Each scar was divided into two halves–control and test. Both halves received topical fluticasone propionate cream 0.05% once daily, silicone gel sheet and a pressure garment. In addition, the test half received microneedling therapy followed by fluticasone propionate cream 0.05% application twice weekly for twelve sittings. The two halves were evaluated for response using the Vancouver Scar Scale (VSS) at the beginning and end of therapy. Results: Twenty patients completed the study. No statistically significant difference was noted in the VSS scores of the two halves. Subjective relief of pruritus was found to be statistically significant in the test half. Conclusion: This study found that percutaneous microneedling assisted steroid therapy as per the the regimen used in this study produced no objectively assessed benefit in the management of hypertrophic scars. Relief of pruritus was noted.
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Exploring attributes influencing patient satisfaction in a group of hospitals p. 89
Ilankumaran Mookkiah, MV Singh, Saurbh Bobdey, Shankar Narayan, N Anand, Kiran Kumar Maramraj
DOI:10.4103/jmms.jmms_158_20  
Introduction: The main purpose of hospitals is to provide quality care to their clientele. Many studies have been conducted to assess patient satisfaction and suggest measures to improve patient satisfaction in government and private hospitals. This study was conducted in a different setting with the aim to assess patient satisfaction in a group of hospitals exclusively for their entitled clientele. Materials and Methods: The study was a questionnaire-based observational study conducted in nine hospitals belonging to one central administration. The questions pertained to five domains. The data were collected on a numerical scale and the weighted average was calculated for each question. Results: A total of 2850 patients were administered with questionnaire. About 95% of patients were satisfied with services provided by the hospitals. The strengths of the hospitals were the general cleanliness and the way the medical and paramedical staff treat their patients. The weaknesses were the waiting period at reception and to see the doctor as well as the quality of food provided to the inpatients. Conclusion: This study has brought out that a large percentage of patients were satisfied with the services provided by the hospitals. The analysis has facilitated the administrator to know the strengths of the hospitals as well as to identify the weaknesses. It is essential that the administration of the hospitals addresses the weaknesses to further improve the patient satisfaction. In conclusion, it is recommended that patient satisfaction surveys should be part of the Standard Operating Procedure of all health-care facilities and the same should be an ongoing process rather than a one-time measure.
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Causes, frequencies, and predictors of relapse in patients with ulcerative colitis on long-term follow-up in a tertiary care hospital of Northern India p. 94
Rahul Jain, Vani Singh, AK Naik, Santosh Kumar Singh, Barun Kumar Chakrabarty, Priya Ranjan, Premshankar Kumar
DOI:10.4103/jmms.jmms_182_20  
Context: Ulcerative colitis (UC) initially thought to be a disease of developed world is equally common in India. Surprisingly, there are very scant data from India. The study was undertaken to find the frequency of relapse and to determine factors predictor of relapse in Indian population. Subjects and Methods: This study was conducted at a tertiary care center of New Delhi for a period of 1 year. Patients were included if they had a diagnosis of UC based on accepted historical, endoscopic, histological, and/or radiologic criteria. Detailed past/present history, baseline clinical examination, dietary details, and psychological analysis using shortened Depression Anxiety Stress Scale score, biochemical tests, inflammatory markers, endoscopic, and histopathological analysis were done at baseline and regular intervals. The outcome was clinical relapse or continued remission. Results: Out of 86 patients screened, 50 patients were included in the study according to inclusion criteria and were followed up. The frequency of relapse was 32%. Univariate analysis showed higher relapse frequency, frequency of steroid received in past, patients on immunomodulator therapy, presence of acute or chronic inflammatory cells on histology, and disease activity at baseline as predictors of relapse. There was no significant difference between anxiety, stress, and depression relapsers and those who maintained remission. On multivariate analysis, disease activity at baseline was the only independent predictor of relapse. Conclusions: Stringent control of disease activity with mucosal healing should be the aim, as mucosal healing is the only predictor for prolonged remission.
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Covishield™ (ChAdOx1) vaccine effectiveness and epidemiological risk factors of COVID-19 infection among frontline workers during second wave of COVID-19 pandemic, New Delhi: A case–control study p. 101
Kiran Kumar Maramraj, Sougat Ray, Kaushik Roy, Ajit Gopinath, Sudeep Naidu, Naveen Chawla
DOI:10.4103/jmms.jmms_137_21  
Background: Frontline workers were the first cohorts vaccinated with Covishield™ (ChAdOx1 nCoV-19) vaccine with dose-interval of 4–6 weeks. We evaluated vaccine effectiveness (VE) of Covishield and studied epidemiological risk factors associated with COVID-19 during second wave of COVID-19 pandemic. Methods: We conducted a 1:3 case-control community-based study, as per WHO protocol. We identified case-patients from COVID-19 surveillance system and recruited controls from the same community as per the WHO protocol. Information was obtained through questionnaire; and all potential confounders were identified to evaluate VE. Results: We enrolled 243 case-patients and 712 controls. Adjusted VE of fully vaccinated was 74% (95% confidence interval [CI]: 53%–86%) against infection and 91% (95% CI: 78%–97%) against moderately severe disease. Pre-infection high-risk exposure events such as ccontact with COVID-19-positive patient, visit to a crowded place, and attending social-gathering in confined space were significantly associated with contracting infection, with odds ratios 10.1 (95% CI: 5.6–18.3), 6.0 (95% CI: 1.8–20.2) and 3.9 (95% CI: 1.4–10.5) respectively. The use of double-mask and past COVID-19 infection was 60% and 70% protective, respectively. Conclusion: Covishield vaccine is highly effective against infection and mainly against disease-severity during high-transmission settings. We recommend three-layer shield to minimize breakthrough and re-infections comprising of vaccination, double-masking, and avoiding “pre-infection high-risk exposure events.”
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