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ORIGINAL ARTICLES
Hydroxychloroquine as pre-exposure prophylaxis against COVID-19 in health-care workers: A single-center experience
Sheila Samanta Mathai, Vineet Behera, Vivek Hande
November 2020, 22(3):98-104
DOI:10.4103/jmms.jmms_115_20  
Background: Health-care workers (HCWs) are at high risk of acquiring COVID-19. Hydroxychloroquine (HCQ) possesses in vitro antiviral activity and inhibits viral replication of coronavirus in cell cultures. The national task force for COVID-19 in India recommended the use of HCQ prophylaxis against severe acute respiratory syndrome coronavirus 2 infection in HCWs. Methodology: We conducted a retrospective cohort study in a mixed tertiary care facility to find the incidence and clinical profile of COVID-19 in HCWs between April 2020 and June 2020, who were advised preexposure prophylaxis with HCQ, at the start of the pandemic. Details of HCQ usage were collected using an online questionnaire form. The clinical profile, treatment, and outcome of COVID-19-positive HCWs were also studied. Results: We included 604 HCWs, of which 491 (81.2%) had taken adequate HCQ prophylaxis while 113 (18.7%) did not take adequate HCQ, 443 (73.3%) had high-risk COVID-19 exposure, and 32 HCWs (5.1% of the total) were COVID-19 positive. There were 10 COVID-19 cases (2.1%) among HCWs taking HCQ while 22 (19.4%) cases occurred in HCQ not compliant HCWs, with a relative risk of 0.1046 (95% confidence interval: 0.0510–0.2147, P< 0.0001), indicating a reduced risk of COVID-19 among HCWs taking HCQ prophylaxis. Among the noncompliant cases, 14 (43.7%) never took HCQ, 4 (12.5%) took HCQ but had poor compliance, and 4 (12.5%) stopped HCQ prematurely. Most (91.7%) COVID-19-positive HCWs were asymptomatic or had mild symptoms, moderate symptoms were seen in 3 (9.3%), and there were no severe cases or deaths. Conclusions: The use of HCQ as preexposure prophylaxis in HCWs was associated with reduced risk of COVID-19, suggesting its role as an effective chemoprophylactic agent.
  17,843 219 -
PERSPECTIVE
Going viral – Covid-19 impact assessment: A perspective beyond clinical practice
Saurabh Bobdey, Sougat Ray
January-June 2020, 22(1):9-12
DOI:10.4103/jmms.jmms_12_20  
In the realm of infectious diseases, a global outbreak is a worst-case scenario. In the past, outbreaks such as plague, Spanish flu, severe acute respiratory syndrome, and H1N1 (swine flu) have caused great human suffering. The novel coronavirus, christened as Covid-19, is a zoonotic disease which originated from the Wuhan province in China and spread like wildfire killing people and devastating the global economy. Mammoth efforts are still on to control this viral strain from further spread. Cities have been blocked, air travel banned, ships have been quarantined, and panic-stricken people have been evacuated from China. As Covid-19 continues to ravage countries across the globe, this article is an effort to provide an overview of the impact of Covid-19 and tickle wits of intellectuals to think how easily a nanometer organism can virtually bring down superpowers of the world.
  10,801 1,729 17
MEDICAL HISTORY
Unknown facets of “not so well-known scientist” Dr. Y Subbarow: A great scientist, who did not receive the Nobel Prize
Vasant S Dixit
July-December 2018, 20(2):141-144
DOI:10.4103/jmms.jmms_69_18  
Dr. Subbarow (January 12, 1895–August 08, 1948) had obtained admission to MBBS course but was awarded Licentiate of Medicine and Surgery instead of the MBBS degree. He went to the USA in October 1923 where he was admitted to the Harvard School of Tropical Medicine. After receiving a diploma from the school, he became interested in biochemistry. He discovered the function of adenosine triphosphate as an energy source in the cell. Despite the path-breaking discovery, Subbarow was denied tenure at Harvard. Subbarow felt that the giant pharmaceutical firms might offer greater scope for research than universities. Hence, in 1940, he joined the world-renowned Lederle Laboratories as Director of Research and spent the rest of his life in the USA. He would lead some of America's most important medical research during World War II. His output and contributions to human biology and medicine are seminal and phenomenal. His creativity is evident in the trail-blazing discoveries in the fields of biochemistry, nutritional science, pharmacology, microbiology, and oncology. Subbarow had craved for fame but was never in the limelight. He pushed into limelight those whose dedication most nearly matched his own. He was proud of the brilliant members of his research teams. He was quick to share successes with colleagues and was known for his acts of generosity. Subbarow said, “Victories of science are rarely won single handedly. No one man should get the (entire) credit.”
  11,542 277 -
MILITARY HISTORY - REVIEW ARTICLE
War and epidemics: A chronicle of infectious diseases
Kaushik Roy, Sougat Ray
January-June 2018, 20(1):50-54
DOI:10.4103/jmms.jmms_34_18  
Disease transmission occurs with a perfect balance of the epidemiological triad consisting of an external agent, a susceptible host, and an environment that brings the agent and host together. Conflict situation is an ideal platform that creates this confluence of agent and host in perfect environmental conditions, for pathogens to tear through soldiers and refugees alike. Classically during armed conflicts, soldiers and displaced population get exposed to unsanitary and overcrowded barracks, trenches, refugee shelters, and concentration camps with disruptive health-care services. Many get susceptible to diseases prevalent in the relocated region and some may introduce pathogens in the native population. The earlier wartime epidemics were considered as divine interventions and wrath of God. As medicinal knowledge advanced, prevention strategies evolved from isolation and quarantine to sanitary measures against miasma and further to chemoprophylaxis and immunization against the pathogen. The advent of antivector chemicals and antibiotics revolutionized the control of epidemics during the World War II. Although not infectious in origin, modern-day outbreaks are mostly health events such as posttraumatic stress disorders in postwar or war-like scenario. This article chronicles the epidemiology of the better-known wartime epidemics.
  8,638 590 2
ORIGINAL ARTICLES
Role of “bladder care bundle” and “infection control nurse” in reducing catheter-associated urinary tract infection in a peripheral hospital
Parli Raghavan Ravi, MC Joshi
July-December 2018, 20(2):116-121
DOI:10.4103/jmms.jmms_8_18  
Background: Care bundles are an effective means of reducing catheter-associated urinary tract infection (CAUTI) when they are implemented with high impact interventions. Care bundle approach only works when every element of the bundle is implemented for every appropriate patient, every time and with high impact. Aim: This study aims to study the efficacy of CAUTI Care Bundle and of infection control nurse (ICN) in reducing the incidence of CAUTI in a zonal hospital. Materials and Methods: The study was with an initial baseline phase (observational) of 8 months followed by an intervention Phase of 21 months. The intervention phase was further divided into intervention Phase I (8 months) and intervention Phase II (13 months). Intervention Phase I included a multidimensional approach of education and training of health-care staff for catheter management and prevention of CAUTI and implementation of catheter care bundle. In intervention Phase II education of health-care workers and implementation of catheter care bundle was done under constant supervision and guidance of ICN. Results: We recorded a total of 834 urinary catheter days: 309 in baseline phase, 314 in intervention Phase I, and 211 in intervention Phase II. It was found that the incidence rate of CAUTI, measured as episodes per 1000 catheter days is 64.72 in baseline phase, 25.47 in intervention Phase I, and 18.95 in intervention Phase II. The catheter care bundle approach along with education of the staff reduced the CAUTI incidence by 60.64 and when the same was applied under the constant supervision of ICN for the CAUTI reduction rate was clinically significant with 70.72. Conclusions: The catheter care bundle approach along with the education of the staff reduced the CAUTI incidence by 60.64 episodes/1000 catheter days and when the same was applied under constant supervision of ICN for the CAUTI reduction rate was clinically significant with 70.72
  8,345 411 -
Efficacy of different types of phototherapy units on neonatal hyperbilirubinemia
Krishna M Adhikari, Sheila S Mathai, Sathya M Moorthy, Naveen Chawla, Sandeep Dhingra
July-December 2017, 19(2):99-102
DOI:10.4103/jmms.jmms_59_17  
Context: Phototherapy is the mainstay of treatment for about 3% of neonates in India who develop significant jaundice in phototherapy range. New devices have been introduced in the market over the past few years. Aims: To compare the efficacy of three types of phototherapy machines, namely Blue and White, Compact Fluorescent Lamp, and Light Emitting Diode type. Settings and Design: A non-randomized prospective interventional study conducted in a tertiary care hospital of Western India. Material and Methods: Ninety neonates with phototherapy range hyperbilirubinemia were assigned into three groups of 30 neonates each to receive phototherapy using one of the three types of phototherapy machines. Need for exchange transfusion, total serum bilirubin (TSB) at 24 hours post-phototherapy and side effect profile were recorded. Decision to stop phototherapy was based on acceptable reduction of serum bilirubin to below phototherapy range. Statistical analysis used: Medcalc® Version 11.4.2.0 Software was utilised. Comparison of mean TSB was done using one way ANOVA. P-value of <0.05 was considered significant. Results: Baseline parameters, TSB at 24 hour post-phototherapy and at the point of stopping phototherapy in the three groups was not significantly different. None of the babies required exchange transfusion or stopping of therapy. Transient rash was the most commonly observed side effect. Conclusions: The three types of phototherapy equipment studied were comparable in efficacy as measured by need for exchange transfusion and mean TSB values at 24 hrs post-phototherapy. The side effect profile was similar and was not significant enough to stop phototherapy.
  7,795 386 3
Study of lifestyle diseases among workers of an ammunition factory
Arun Gupta, Neeti Goyal, AK Jindal, Raj Kumar
January-June 2017, 19(1):43-47
DOI:10.4103/jmms.jmms_3_16  
Background: Lifestyle diseases which include hypertension, type 2 diabetes mellitus, obesity, and stroke are caused by influences on the human body by the way people live their lives. This study is an effort to describe the prevalence of various lifestyle diseases; factors associated with their causation and suggest measures for improvement of the health status among the industrial workers. Materials and Methods: A total of 351 workers were included in this study. The prevalence and pattern of lifestyle diseases among industrial workers were studied. The survey had two principal components, namely, the pretested standardized questionnaire and clinical examination. Blood sugar levels were assessed by a glucometer. Results: Hypertension was the most common lifestyle disease, seen among 43.0% of workers. It was significantly related to age, socioeconomic status type 2, body mass index (BMI), and habit of tobacco chewing. Only one-fourth were aware of their blood pressure status. Other diseases brought out were diabetes type 2 mellitus (7.7%) and obesity (4%). In this study, among those with type 2 diabetes mellitus, 29.63% were not aware of their blood sugar status. Diabetes was significantly related to BMI and increased significantly with increase in age. Also, one-third of the study population was overweight. Conclusion: Lifestyle diseases were found to be the major causes of morbidity among the study participants. Hypertension, type 2 diabetes mellitus, and overweight/obesity were the common morbidities. These conditions were associated with factors such as age, socioeconomic status, BMI, and history of tobacco chewing.
  7,420 347 2
Talcum powder and photoprotection
Jandhyala Sridhar, CR Srinivas
January-June 2017, 19(1):48-50
DOI:10.4103/jmms.jmms_35_17  
Context: Talcum powder is a popular daily use cosmetic product in India with a high urban and rural penetration. Aim: To examine the photoprotective ability of a popular brand of talcum powder. Design: Nonrandomized controlled efficacy study. Subjects and Methods: Minimal erythema dose (MED) following narrowband ultraviolet B irradiation among ten volunteers was recorded. Sun protection factor (SPF) of talcum powder was determined by standard in vivo method. Percentages of zinc oxide in the test sample and ten other commercially available brands of talcum powder were estimated by atomic absorption spectrophotometry. Statistical Analysis Used: Calculation of mean. Results: The mean MED of volunteers was 310 milli Joule (mJ) without talcum powder and 400 mJ with talcum powder. The mean SPF of talcum powder was 1.29. The percentage of zinc oxide in the test sample was estimated to be 1.5%. Conclusions: Talcum powder offers low photoprotection due to low zinc oxide content.
  5,629 226 -
Seroprevalence of cytomegalovirus infection in antenatal women in a Tertiary Care Center in Western India
Mahadevan Kumar, Mohammad Bashir Nizam, M Mugunthan
January-June 2017, 19(1):51-54
DOI:10.4103/jmms.jmms_26_17  
Context: Human cytomegalovirus (CMV), otherwise called human herpesvirus 5, is a member of the Herpesviridae family. Maternofetal transmission of CMV can occur during pregnancy following primary or recurrent infections in the mother. Infections in utero are associated with fetal abnormalities, intrauterine growth retardation, and intrauterine death. In India, 80%–90% of the adult population show presence of CMV antibodies; however, there are few articles showing the prevalence of CMV infection in pregnant women. Aims: The aim of this study is to assess seroprevalence of CMV infection in antenatal women. Settings and Design: This is a cross-sectional, observational study, study population: women reporting for antenatal care to the OPD at a tertiary care hospital. Subjects and Methods: Three hundred and seventy serum samples drawn from antenatal women attending OPD in a tertiary care center were tested for IgG and IgM antibodies by enzyme-linked immunosorbent assay. Statistical Analysis Used: Statistical significance was estimated by calculating “P value.” Results: Of the 370 samples tested, 83% showed the presence of CMV IgG and 9.46% were positive for CMV IgM. All those cases which were IgM positive were seropositive for CMV IgG as well. Sixteen percent of the antenatal women were both IgG and IgM negative. Conclusion: The prevalence of CMV IgG in antenatal women in this region is high. Around 16% of the women showed lack of IgG. It would be beneficial to screen pregnant women for CMV IgM antibodies is beneficial and will help guide the testing of newborns suspected to be infected with CMV in order that appropriate therapy of the infected infants can be instituted promptly and appropriate advice can be rendered on prevention of transmission.
  5,457 386 3
EDITORIAL
Medical challenges of women combatants: Looking to the future
Sheila S Mathai, Ravi Kalra
January-June 2018, 20(1):1-3
DOI:10.4103/jmms.jmms_37_18  
  5,411 400 -
ORIGINAL ARTICLES
Use of levamisole in children with nephrotic syndrome: A retrospective study to examine its adverse effects in children with nephrotic syndrome
Suprita Kalra, Madhuri Kanitkar, Kara Tiewsoh
July-December 2017, 19(2):87-90
DOI:10.4103/jmms.jmms_41_17  
Introduction: Levamisole, a synthetic imidazothiazole derivative has been used as a steroid sparing agent in children with Frequently Relapsing Nephrotic Syndrome (FRNS) and Steroid Dependent Idiopathic Nephrotic Syndrome (SDNS). Levamisole has been essentially considered a safe drug with minimal toxicity. We conducted this study to re-examine the safety of Levamisole in children with nephrotic syndrome and to describe the clinical profile of these children. Materials and Methods: Records of children with idiopathic nephrotic syndrome between June 2014 and December 2016 were reviewed. We identified frequently relapsing or steroid dependent children between 1-18 years of age who had received Levamisole for at least six months or in whom Levamisole was started but had to be withdrawn due to some adverse events in the first 6 months. Results: 21 children were started on Levamisole in the study period. 13 (61.90%) were FRNS and remaining had a steroid dependent course. Levamisole had to be withdrawn in one child at 1 month 13 days after initiation when the child developed severe headache. Levamisole also had to be discontinued in a 9 years old girl at 13 months after initiation of therapy due to polyarticular arthralgia involving both the small and large joints. Conclusions: The use of Levamisole warrants caution in children with Nephrotic Syndrome and its efficacy needs to be balanced against its potential side effects.
  5,407 297 1
Knowledge, attitude, and practice toward COVID-19 among pregnant women in a tertiary care hospital during the COVID-19 outbreak
Deep Kamal, Vaidehi D Thakur, Santosh K Swain, CR Vikneshram
November 2020, 22(3):66-71
DOI:10.4103/jmms.jmms_81_20  
Background: During COVID-19 pandemic, Indian health authorities implemented massive measures to control the rapid spread of infection. Nonetheless, even during pandemic, pregnant women need constant obstetrics consultations during the antepartum period and adequate care during intrapartum and postpartum period for uneventful outcome. Undeniably, adherence to these control measures is largely affected by knowledge, attitude, and practices (KAP) towards COVID-19. Aims and Objectives: To assess knowledge, attitude, and practice towards COVID-19 amongst pregnant women and to find the association of demographic variables (age, place of residence, and education) with KAP. Materials and Methods: The cross-sectional, descriptive study was conducted for pregnant women attending the outpatient department of Obstetrics in a tertiary care Defense hospital. We investigated 506 pregnant women serially from Obstetrics OPD of the hospital for KAP towards COVID-19 with a questionnaire of 14 questions. The study population was assessed for the KAP score and association of demographic variables with KAP. Descriptive statistics were used to describe the findings. Median and standard deviation (SD) were calculated for KAP and Pearson's Chi-square test was used to analyze the association of demographic variables with KAP. Results: In our study scores for adequate knowledge, positive attitude, and good practices were 75.3 %, 73.9%, and 92.7 % respectively. The analysis of the association of various demographic variables with KAP about COVID-19 revealed significant association. Conclusion: The majority of pregnant women was knowledgeable about COVID-19 and had positive attitude and good practices. However, health authorities may need to take proactive steps for this vulnerable subpopulation.
  5,160 436 2
REVIEW ARTICLES
COVID-19 in healthcare workers: A review of existing literature
Vineet Behera, Pramod Kumar Srivastava, Jayakrishnan Jayaramachandran, Sougat Ray, Vivek Hande, Sheila Samanta Mathai
November 2020, 22(3):36-45
DOI:10.4103/jmms.jmms_133_20  
Background: Healthcare workers (HCWs) are particularly at a risk of acquiring COVID-19 infection. The pattern of disease and outcome in HCWs has not been studied adequately. This review was done to determine the prevalence of COVID-19 in HCWs and to find out the clinical profile and mortality of COVID-19 in HCWs. Materials and Methods: A systematic search of all published or in press studies from January 1, 2020, to July 15, 2020, with confirmed COVID-19 HCWs was done in PubMed, Scopus, and Google Scholar and in other key journals using terms such as “2019-nCoV,” “novel coronavirus 2019,” “COVID-19,” “SARS-CoV-2,” “Wuhan coronavirus,” “health care worker,” “health care professional,” “physician,” and “medical staff.” Results: We analyzed 43 research articles, mostly cross-sectional studies with 20 studies from China, and included 13,725 COVID-19–positive HCWs. Proportion of COVID-19–positive HCWs (n = 8405) among all HCWs (n = 276,392) were 3.04% (95% confidence interval [CI]: 0.62–9.76), while the proportion of positive HCWs (n = 9458) among all COVID-19–positive patients (n = 230,626) were 4.1% (95% CI: 1.44–12.46). The mean age of HCWs was 42.78 ± 6.82 years, 34.47% were males, and 51.04% were nurses. Most COVID-19–positive HCWs were asymptomatic (64.41%), while severe disease occurred in 4.08% with a mortality of 0.80% (47/5823). The incidence of severe disease and mortality among HCWs (n = 9458) and general population (n = 230,626) was extracted from nine studies, and it was seen that severe disease (1.7%) or mortality (0.04%) in HCWs was significantly less as compared to non-HCWs population (8.26% and 1.23%, respectively) (P < 0.001). Conclusion: There is a considerable risk of contracting COVID-19 infection among HCWs which re-emphasizes the strong need of personal protective measures. However, the incidence of severe disease and deaths is significantly low among HCWs, which may somewhat reduce apprehension and be morale boosting for HCWs all across the world.
  4,884 191 1
ORIGINAL ARTICLES
Thoracic epidural analgesia for breast oncological procedures: A better alternative to general anesthesia
Parli Raghavan Ravi, Pradeep Jaiswal
July-December 2017, 19(2):91-95
DOI:10.4103/jmms.jmms_57_17  
Objective: The objective of the study was to compare the outcomes of the incidence of nausea/vomiting and other complications along with the time taken for discharged in patients undergoing Thoracic Epidural Analgesia (TEA) and General Anaesthesia (GA) for breast oncological surgeries. Background: GA with or without TEA or other postoperative pain-relieving strategies remains the traditional anesthetic technique used for breast oncological procedures. We initiated the use of high segmental TEA for patients undergoing these procedures in our hospital. Methods: Eighty patients undergoing breast oncological procedures performed by one surgical team were randomly allocated into two groups receiving TEA and GA. The Chi-square test and Fisher's exact test were used for categorical parameters, paired t-test and Student's t-test was used for continuous measurements. Results: In comparison with GA, TEA was associated with lesser incidence of complications of nausea/vomiting. In lumpectomy with axillary node dissection, 1 out of 18 patients (5.55%) in the TEA group had nausea/vomiting, while 11 out of 19 (57.8%) of the GA group had similar symptoms (P < 0.001). The discharge rate for the thoracic epidural group was 12 out of 18 by day 3 (66.6%) while all patients in the GA group required more than 3 days of hospitalization (P < 0.001). Conclusion: Thoracic epidural anesthesia is a safe technique and its use in breast oncological procedures could improve patients' recovery and facilitate their early discharge to home.
  3,869 536 2
REVIEW ARTICLES
Role of ivermectin in COVID-19: Wishful thinking or scientific optimism
Prafull Mohan, Sharmila Sinha, Rajdeep Uppal
November 2020, 22(3):27-31
DOI:10.4103/jmms.jmms_146_20  
Ivermectin is routinely used for indications such as strongyloidiasis, onchocerciasis, and scabies. It is also known to possess antimicrobial, anticancer, antimitotic, anti-allergic, and antiviral properties. It has been found to inhibit SARS-COV-2 in an in-vitro study, following which, a lot of interest has been generated regarding its role in the treatment of COVID-19. However, as per extrapolation from in vitro study, the current approved dose of ivermectin may not result in sufficient concentration in the lungs to have an anti-COVID-19 effect. However, a large number of trials using different ivermectin doses are underway to generate conclusive data. If ivermectin fails to show clinical benefit in ongoing trials, additional studies to address its safety at much higher doses, additional mechanisms of its action, and different routes of administration/formulations may be required. As of now, ivermectin shows promise against SARS-CoV-2, but the dose and context of its use remains nebulous.
  4,139 217 -
REVIEW ARTICLE
Psychological screening in the Indian Navy
Neha Sharma, Rohith R Pisharody, Chaitanya Kodange, Kaushik Chatterjee, Sunil Goyal, Priyadarshee Patra, Puneet Khanna
January-June 2020, 22(1):5-8
DOI:10.4103/jmms.jmms_10_19  
In the military parlance, screening implies evaluation or investigation of something as part of a methodical survey, to assess suitability for a particular role or purpose. Psychological screening to assess fitness for induction into military service has a long and tumultuous history. From being limited to tests of intelligence, the practice of psychological screening has evolved over the century to now being focused on the assessment of personality and motivation. There are various types of screening tools utilized by the militaries worldwide. They are debatable in their utility in screening out unfit individuals. However they are considered effective in choosing individuals with specific attributes and aptitudes for specific roles within the military. This article reviews the existing system of screening worldwide, derives lessons for the Indian scenario, and the way ahead for psychological assessment in the Indian Navy.
  3,693 324 -
REVIEW ARTICLES
An insight into the elderly mind during COVID-19 pandemic: World Mental Health Day 2020
Ramya Vadakkayil Balan, Divyamol Karunakaran Sasidharan, Jishnu Sathees Lalu
July-December 2020, 22(2):113-117
DOI:10.4103/jmms.jmms_151_20  
About one third of the elderly suffer from mental illness due to psychosocial issues such as loss of spouse, social and financial insecurity, low support from families, inadequate nutrition, uncontrolled hypertension, impaired vision, deafness, and arthritis. Psychological stress can have harmful impact on the immune system, making the elderly more susceptible to SARS-Co-V2. Stigma associated with the disease, risk of developing complications during the course of the disease and relatively high mortality rates put the elderly under immense stress. The older population though knowledgeable are ignorant of their own health. The prevalent COVID-19 pandemic imposes more challenges to the elderly population which demands a holistic approach directed to meticulous solutions.
  3,726 274 1
ORIGINAL ARTICLES
Food poisoning outbreak in a training establishment: A retrospective cohort study
Maramraj Kiran Kumar, Vijay Bhaskar, Sougat Ray
January-June 2017, 19(1):28-33
DOI:10.4103/jmms.jmms_17_17  
Background: An outbreak of food poisoning occurred among recruits in a training establishment. Investigation of outbreak was undertaken with active preventive interventions concurrently to arrest the current outbreak as well as to avoid such incidents in future. Materials and Methods: A retrospective cohort study was undertaken among all recruits, regardless of presence or absence of symptoms. The risk ratios (relative risks) and attributable risks were calculated for each food item of the suspected meal to assess the association between consumption of individual food items and subsequent illness. An environmental survey was undertaken to investigate into the course of food processing and storage facilities at trainees' galley (cookhouse) and other relevant eating establishments. Results: A total of 494 recruits reported with symptoms of gastroenteritis in a span of 3 days. Of those affected, only 9 were admitted and rest recovered with treatment on OPD basis. The overall attack rate was 22.9%. No deaths were reported. It was a classical point source, single exposure gastroenteritis outbreak. When food histories and sickness histories were analyzed, the attributable risk (24.17) and relative risk (5.11) were highest for the “Flavoured milk,” which was an outsourced item. The statistical findings were substantiated with environmental and epidemiological evidence. Conclusion: Epidemiological investigation incriminated dinner of the previous day as the meal responsible for the outbreak with flavored milk as the most attributable food item.
  3,458 362 -
Spinal cord injury in organizational setup - A hospital based descriptive study
Gurpreet Singh, Rajat Prakash, Vijay K Bhatti, Ajoy Mahen
January-June 2019, 21(1):46-50
DOI:10.4103/jmms.jmms_67_18  
Introduction: There is dearth of data on Spinal Cord Injury (SCI) from developing countries where ironically, special focus is required. Aims and Objectives: To study SCI in an organisational set up. Material and Methods: An observational, cross sectional study at a tertiary care rehabilitation centre was conducted. Patients who had injury during service were included. Questionnaire and case records were used to collect socio-demographic variables, cause, level, severity and duration of injury and clinical, functional and psychological status. Organisational support was estimated for pre-hospitalisation services, inpatient welfare measures and post-hospitalisation rehabilitative services. Results: A total of 157 patients participated. Median age at time of injury was 27 years with 89.2% injuries within 18 - 37 years of age. Trauma was underlying cause in 94.3%. Most common level of injury was thoracic (37.6%) and majority (66.9%) were paraplegic. RTA was most common (42.6%) traumatic cause and Tuberculosis among non-traumatic causes(66.6%). Scores suggestive of stress disorder were present in 13%. Pre-hospitalization health facilities were available to 79.6%. Majority (59.2%) had access to health facilities within two hours. Personal assistance was available to 88.5% and 66.9% undertook rehabilitation course. Conclusion: Health education with emphasis to trauma prevention in young is required. Social security measures need to be replicated by all organisations, both public and private in the country.
  3,458 300 2
CASE REPORTS
Anesthetic challenges in leaking meningomyelocele repair in a neonate
Vidhu Bhatnagar, SN Kulkarni, MD Muzammil
July-December 2019, 21(2):189-192
DOI:10.4103/jmms.jmms_71_18  
Meningomyelocele is a neural tube defect, which comprises of a saccular protrusion containing a neural placode bathed in cerebral spinal fluid. Arachnoid covers the surface of the sac and dura or skin is missing. This is a congenital spinal anomaly, a type of spina bifida where there is a failure of fusion of spine. Early surgery is advisable because of increased risk of infection and further damage to nervous tissue. Anesthetic challenges for meningomyelocele surgical repair in a neonate include intubation with proper positioning to avoid rupture of sac, intraoperative prone position ventilation and its related complications maintenance of anesthesia, temperature control, and fluid management. We present a case report of anesthetic challenge of a 2-day-old neonate for detethering and repair of lumbosacral meningomyelocele.
  3,321 372 -
EDITORIAL
Paramedical training in the armed forces: Need for a paradigm shift
Alhad Anant Pawar, Sheila S Mathai
July-December 2017, 19(2):81-82
DOI:10.4103/jmms.jmms_1_18  
  3,341 277 -
ORIGINAL ARTICLES
Induction of labor: Our experience
Sushil Chawla, Santosh Kumar Singh, Monica Saraswat, Sakthi Vardhan
July-December 2017, 19(2):96-98
DOI:10.4103/jmms.jmms_51_17  
Introduction: Induction of labor is a deliberate attempt to terminate the pregnancy with the aim of vaginal delivery in cases of valid indication. Different methods are being used ranging from nonpharmacological to pharmacological for the same. Induction on demand by patients is also rising in our country. Objectives: The aim of this study is to ascertain the common indications for induction of labor at a tertiary care teaching hospital. Materials and Methods: A prospective observational study, with the study group being all the patients who underwent induction of labor and the total population including all the women delivering at our center, in 1 year. The induction was done using “Dinoprostone” gel or tablet “Misoprostol”. Results: Postdated pregnancy was the reason for induction of labor in 36% of the patients. Hypertensive disorders and gestational diabetes mellitus are other common conditions requiring induction of labor. Pregnancy following assisted reproductive techniques form an important group requiring induction of labor in present day practice. Conclusion: Hypertensive disorders and postdated pregnancy are the most common indication for induction of labor.
  3,251 342 3
Medical management of patients with benign prostatic hyperplasia: A study in Indian population
Amit Kumar Shah, Anand Srivastava, SC Karan
July-December 2018, 20(2):104-110
DOI:10.4103/jmms.jmms_22_18  
Introduction: At present, the geriatric population has formed a large clientele for medical services, with an increased incidence of lifestyle diseases. Approach to lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) is an upcoming challenge, especially with management showing a paradigm shift toward medical management. This study was basically designed to study the outcome of medical management of BPH on Indian population following the recommendations based on recent guidelines on medical management of BPH. Materials and Methods: With a calculated sample size of 131 based on the prevalence of BPH, a total of 170 patients were enrolled, and their complete profile with clinical examination, imaging and International Prostatic Symptom Score details were taken as per proforma and were followed up while on medical management and assessed on a cross-sectional basis at regular intervals. Results: The mean age in the study group was 64.61 years. We recorded that all patients had some formal education. These patients were prescribed α-1ablockers as monotherapy or combination therapy as per the protocol of the study. They showed improvement while on medical management with significant improvement. Adverse reactions of medical management were not significant enough to warrant discontinuation of therapy. Forty-one patients out of 170 underwent surgery for no response or worsening quality of life. This group was further analyzed which revealed that comorbid condition, prostate size, and body mass index had no association with the outcome. Conclusion: There is sufficient evidence to support the paradigm shift in the management of BPH. The present guideline is to initiate medical management with monotherapy for patients with BPH and prostate size <30 g and combination therapy for larger prostate sized >30 g. Surgery is advised for patients who do not respond to medical therapy and for the subgroup of patients with absolute indication for surgery in BPH.
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CASE REPORTS
Staged total penile reconstruction using flap prefabrication and arteriovenous loop
Pauline Babu, Pallab Chatterjee, Parli Raghavan Ravi
January-June 2018, 20(1):79-82
DOI:10.4103/jmms.jmms_14_18  
Loss of penis due to injury or disease is physically and psychologically devastating to any male. While the technique of penile reconstruction continues to evolve in conjunction with the evolution of flaps in reconstructive surgery, the free tissue transfer using radial artery forearm flap (RAFF) in a single stage is recognized as the most preferred method at present. However, to avoid the complications often seen in such single-stage method, we used a novel two-stage technique for total penile reconstruction in two cases after penile loss. We prefabricated the neophallus in the forearm and constructed saphenofemoral arteriovenous loop in the groin in the first stage to allow all the suture lines to heal and provide for easy and reliable recipient vessels. The neophallus was transferred after 4 weeks and vessel anastomoses done conveniently in the groin with adequate sized vessels with robust inflow. Both the patients recovered well without any need for urinary diversion and quickly attained the ability to pass urine in standing position. We offer that the two-stage method of penile reconstruction using free RAFF is reliable, easy to perform and can avoid many of the complications seen with single-stage reconstruction.
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LETTERS TO EDITOR
Renal cell carcinoma with inferior vena cava extension: An anesthetic challenge
MK John, Nihar Ameta, Jacob Mathews, Sarvesh Shrivastava
January-June 2017, 19(1):70-71
DOI:10.4103/jmms.jmms_40_17  
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