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   Table of Contents - Current issue
Coverpage
May-August 2019
Volume 5 | Issue 2
Page Nos. 45-101

Online since Tuesday, August 20, 2019

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EDITORIAL  

Dr. Google – Bane or Boon? p. 45
R. N Sahai
DOI:10.4103/mamcjms.mamcjms_56_19  
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REVIEW ARTICLES Top

Abdominal Compartment Syndrome: A Comprehensive Pathophysiological Review p. 47
Lovenish Bains, Pawan Lal, Anurag Mishra, Amit Gupta, Kamal Kishore Gautam, Daljit Kaur
DOI:10.4103/mamcjms.mamcjms_32_19  
With growing knowledge and advances in surgery and critical care, we are witnessing new concepts and understanding in spectrum of disease pathology. Abdominal compartment syndrome (ACS) or intraabdominal hypertension (IAH) is one such intriguing entity that has rapidly caught attention of all surgeons and intensivists. Lately, lot of researches are showing the correlation of ACS-IAH with worse outcomes and even mortality in sick patients. IAH has been found to be an important contributor to early organ dysfunction among patients with trauma and sepsis that can cause significant impairment of renal, gastrointestinal, hepatic, cardiac, pulmonary, and central nervous system function. The pathology is even more significant in cases of abdominal surgery or trauma. ACS-IAH is commonly seen in severely sick patients, with prevalence reaching to as high as 50%. There is an increasing awareness of IAH as evidenced by increasing number of studies in the literature. Although there is lot of documented evidence around the topic of ACS-IAH, measuring and managing it still does not figure in most of protocols and practice guidelines in India. The authors believe that a thorough understanding about IAH will enable medical professional in reducing surgical mortality and morbidity. Hence, there was a need to review literature for the latest concept and evidence especially in the area of ACS-IAH, in context of our country India, where there is dearth of knowledge in this subject and its implications. The present review is set to present the current understanding of IAH from pathophysiological and clinical point of view with future insights.
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Ectopic Thyroid Tissue in Submandibular Region p. 57
Rahul Karna, Jyoti Kumar, BT Srividya, Anjali Prakash, Ishwar Singh, Anju Garg
DOI:10.4103/mamcjms.mamcjms_18_19  
Ectopic thyroid is the presence of gland at any location except for its normal position in the anterior neck in front of the trachea. It may result from an early arrest of migration or migration along an abnormal path. Ectopic thyroid in the submandibular region is relatively unusual and may or may not be accompanied with the orthotopically located thyroid gland. Pathological changes reported in the literature in the ectopic gland include goitrous change, hyperplasia, malignancy, and, rarely, inflammation. Patients usually present as a palpable, mobile, and painless mass below the lateral jaw. The important differentials include salivary gland tumor, lymphoma, inflammatory lymphadenopathy, lipoma, and cysts. Ultrasonography, radionuclide scan, computed tomography, and magnetic resonance imaging are the diagnostic modalities for documenting the presence of ectopia. Evaluation of functional status with thyroid profile and histopathological examination after fine-needle aspiration cytology directs further management. Surgical removal is the preferred treatment for ectopic thyroid. Thyroidectomy predisposes the patient to iatrogenic hypothyroidism if eutopic thyroid is absent or hypofunctioning. Such patients require lifelong thyroid replacement. However, asymptomatic cases may be managed conservatively. Ectopic thyroid in the submandibular region has important clinical implications and hence, even though rare, should be considered as one of the differentials in the patient presenting with swelling below the lateral jaw.
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ORIGINAL ARTICLES Top

Comparison of Modified Atlanta Classification With Modified CT Severity Index in Acute Gallstone Pancreatitis p. 63
Gumi Padu, Pawanindra Lal, Anubhav Vindal
DOI:10.4103/mamcjms.mamcjms_13_19  
Acute Pancreatitis is one of the commonest gastro-intestinal diseases, in which patients need emergency hospitalization. It carries 10-30% mortality in severe cases. Early identification of severe cases helps in prognostication of the disease and institution of aggressive treatment. Aim To evaluate the severity of acute gall stone pancreatitis using Modified Atlanta Classification at admission and 48 hours. To compare severity of acute pancreatitis as assessed by Modified Atlanta Classification with Modified CT Severity Index (CTSI) in the second week. Materials and Methods We use Modified Marshal Score, as recommended by Revised Atlanta Classification, in our study group of 26 patients. Patients were classified into Mild, Moderate, and Severe categories at 48hrs. Contrast Enhance Computer Tomography of chest and abdomen (Gold standard) was performed at 2 weeks of presentation. Using Modified CTSI Score, patients were again categorised into Mild, Moderate, Severe cases. Results Modified Atlanta Classification correctly picked up the severe pancreatitis cases, as early as at 48hrs, with 100% sensitivity and specificity, which corresponded with CTSI at 2wks.
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Analysis of Hanging Cases Brought to Mortuary of Lok Nayak Hospital, New Delhi: A 3-Year Retrospective Study p. 69
Dhiraj D Buchade, Rohit Bharti, Arthy Amarnath, Anil Kumar Mittal, Sunil Kumar Khanna
DOI:10.4103/mamcjms.mamcjms_24_19  
The incidence of hanging as a means adopted for committing suicide has been on the rise. Hanging provides painless death so it is one of the commonly adopted methods for suicide. This retrospective study including 173 hanging cases was conducted with an objective to find the pattern of hanging cases as a method of suicide. Male victims constituted 72.8% with male:female ratio being 2.7:1. Young adults in the age group of 16 to 35 years were more involved. Rainy season recorded maximum cases of hanging, that is, 67 cases (38.7%), whereas winter season recorded the least number, that is, 42 cases (24.3%). Most commonly used ligature material in this study in 149 cases (86.1%) was sari/dupatta/bedsheet. Autopsy findings revealed dribbling of saliva in 129 cases (74.6%), cyanosis in 150 cases (86.7%), and petechial hemorrhages on lungs in 115 cases (66.5%). Ligature mark was above the level of thyroid cartilage and parchmentized in all the cases. Additional injuries were present in 1.2% of cases. Neck structures were normal in all the cases and cause of death was mechanical asphyxia in 169 cases (97.6%).
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Analysis of Homicidal Cases Brought to Mortuary of Lok Nayak Hospital, Delhi: A 3-Year Retrospective study p. 73
Dhiraj D Buchade, Rohit Bharti, Arthy Amarnath
DOI:10.4103/mamcjms.mamcjms_30_19  
Destruction of an individual is the most heinous expression of aggression found in any culture. Homicidal investigation requires a scientific and detailed analysis of circumstances and a trough autopsy. And to take a directed step in preventing a crime, the pattern of crime is to be known. The present study was done in Lok Nayak Hospital, Delhi, to observe the trend of homicide. It was seen that males were predominantly involved with higher incidences being in the age group of 21 to 40 years of life. Blunt objects were more frequently used and head injuries were chiefly causing deaths.
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Prescription Audit, Drug Utilization Pattern and Adverse Drug Reaction Monitoring in Outpatients of Orthopedics Department of Tertiary Care Teaching Hospital: A Pilot Study p. 77
Angelika Batta, Nikita Madan, Bhupinder S Kalra, Sumit Arora
DOI:10.4103/mamcjms.mamcjms_33_19  
Background: The domain of orthopedic illnesses is grossly underrepresented in the current healthcare scenario especially due to overreliance on mortality rather than the morbidity or dysfunction. Continuous introduction of new drugs in the field of pharmacology requires holistic utilization, effectiveness, and side-effects studies. In addition, inappropriate use of drugs poses a risk of adverse drug reactions (ADRs). Our study aims to analyze the prescription pattern in outpatient department of orthopedics at a tertiary care hospital of Delhi. Methodology: The study was carried out in 210 patients who attended the orthopedics outpatient department for a period of 3 months. Patient demographic details, duration of illness, comorbid conditions, drugs prescribed, ADRs, and usage of complementary and alternative medicine were used to analyze the pattern of drug use. Results: In our study, we observed that vitamins and mineral preparations (20%) was the most commonly prescribed class of drugs followed by nonsteroidal antiinflammatory drugs (11.42%). Polypharmacy was seen in most of the prescriptions (60.95%), but 100% of the drugs were from Essential Medicine List of Government of National Capital Territory, Delhi. About 75% of the prescriptions were prescribed by generic names. ADRs were reported in 30 patients and majority of them were mild in nature (96%). Complementary and alternative medicine was used by 13.3% of the study patients. Conclusion: Majority of the drugs were prescribed by generic names and were essential medicines. Trend of polypharmacy was noted. Injudicious use of multivitamins and calcium was seen. Nonsteroidal antiinflammatory drugs were a significant part of therapy. ADRs reported were generally mild in severity and involved gastrointestinal tract. Need of the hour is to conduct frequent prescription audits to inculcate good prescribing practices.
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Attitude, Belief, and Perception Toward Mental Illness Among Indian Youth p. 83
Akshat Chowdhury, Kavita Gupta, Ashok Kumar Patel
DOI:10.4103/mamcjms.mamcjms_31_19  
Background: According to World Health Organization (1999), mental health is defined as “subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization that deals with the individual’s awareness, attitude, and belief about the mental disorders.” Hence, the present study was conducted among Indian college students to assess belief, attitude, and perception about causes and treatment of mental disorder (illness) with respect to depression and schizophrenia. Material and Methods: The present descriptive study was undertaken at Amity university, Rajasthan, with a sample of 150 college undergraduate and postgraduate students in the age group of 18 to 27 years by using cases “Vignettes of Depression and Schizophrenia” and “Short Version of Orientation Toward Mental Illness Scale (OMI).” Results: The present study indicated that depression was easily recognizable as compared to schizophrenia among college students. Stressful factors were considered as the primary cause for both depression and schizophrenia. Majority of the participants were convinced of the favorable outcome of both depression and schizophrenia. Conclusion: It was concluded that majority of the participants had negative attitude toward folk therapy, psychosocial manipulation, and physical method of treatment with the perception of family as a main source for seeking help regarding mental illness. Moreover, majority of participants had a belief that mental disorder is a cause for depression and stress is the main cause for schizophrenia among the mental illness. Therefore, the prognosis of both depression and schizophrenia was considered good.
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SHORT COMMUNICATION Top

Violence against Medical Fraternity: Time to Act p. 89
Vidushi Rathi, Pranav Ish
DOI:10.4103/mamcjms.mamcjms_49_19  
Violence against doctors in India has increased in the last decade. The problem is worse in public hospitals, which lack appropriate security protocols. In order to tackle the issue, doctors need to accept the problem, understand the public and collaborate with the authorities to find a solution to prevent the untimely demise of this noble profession.
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CASE REPORTS Top

Faulty nitrous oxide–oxygen interlock or hypoxic device leading to higher concentration of oxygen delivery p. 93
Bhavna Gupta, Kapil Chaudhary, Gunjan Manchanda, Jaspal Singh Dali, Mona Arya
DOI:10.4103/mamcjms.mamcjms_20_19  
A “pre-use check” to ensure the correct functioning of anesthetic equipment is essential to patient safety. The anesthesiologist has a primary responsibility of checking the machine and equipment before administration of anesthesia. We report a case where pre-use check would have failed to check delivery of high oxygen had oxygen analyzer not been used. Incorporation of safety features in anesthesia machines and ensuring that a proper check of the machine is performed before use on a patient ensures patient safety.
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Peutz Jeghers syndrome presenting as intestinal obstruction with ileocolic intussusception: a rare presentation p. 96
M.V. Sathvika, Lakshmi Venkata Simhachalam Kutikuppala, Sesha Deepthi Pratti, Sateesh Kumar Atmakuri
DOI:10.4103/mamcjms.mamcjms_29_19  
Many cases of Peutz Jeghers Syndrome presenting as intestinal obstruction with intussusception at various levels were reported in literature. This is a case of a 35 years old male farmer who presented to our hospital with the chief complaints of brown coloured stools since one month, pain in lower abdomen and bleeding per rectum since one week. All the findings of the examination were suggestive of intestinal obstruction. Further confirmation was made by Abdominal sonography, Contrast Enhanced Computed Tomography of abdomen and Sigmoidoscopy with colonic polyp biopsy. After going through all the investigations, a clinical diagnosis of multiple intestinal polyposis with ileo-colic intussusception and small bowel obstruction was made. Right hemicolectomy with ileo-colic anastomosis was performed and the specimen was sent for histopathological examination. A final diagnosis of Peutz Jeghers Syndrome was made based on Histopathology. Post surgical prognosis was good and the patient was discharged after 13 days. A regular follow up was recommended.
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LETTER TO EDITOR Top

Regarding “The Safety and Efficacy of Frame-Based Stereotactic Biopsy of Brain Lesion” p. 101
Sanjay Dhawan, Tusharindra Lal
DOI:10.4103/mamcjms.mamcjms_46_19  
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