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   2020| January-April  | Volume 6 | Issue 1  
    Online since April 30, 2020

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COVID 19: Understanding the Disease to Implement Containment Strategies
Kirti Singh, Jatinder Bali, Arshi Singh, Nandini Sharma
January-April 2020, 6(1):7-16
COVID-19, the novel coronavirus is a global threat which has hit all with the force of a hurricane. The vast biological and economic impact of this virus threatens to crumble our health resources, if not handled with caution. In order to battle this pandemic on all fronts, awareness of nature of virus, its transmission, virulence clinical features, complications and management options is essential. We as comprehensive ophthalmologists and more importantly as responsible clinicians, need to update ourselves with knowledge pertaining to this novel virus to safeguard our human resources including ourselves against this powerful enemy. The article reviews basic information about etiology, transmission patterns, clinical picture, diagnostics, treatment and preventive measures of this infection. This is in concordance with the maxim “Know thy enemy”. It also stresses on the precautions to be observed by all healthcare personnel to ensure safety and contain spread. We bear onus of becoming aware of spreading this awareness to break the chain of contagion.
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Health-Related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease in Karachi Pakistan—A Cross-Sectional Study
Mubashir Zafar
January-April 2020, 6(1):17-22
Aims and Objective: A chronic obstructive pulmonary disease (COPD) is a major public health problem globally. The patients with COPD usually have dependence on society due to its nature. This study was designed to determine the health-related quality of life among COPD patients and its relationship with severity of disease. Methods: Total 54 patients were recruited through simple random sampling from the outpatient department of a tertiary care hospital. St Georges Respiratory Quality life validated structured questionnaire was used to determine the quality of life under cross sectional study design. Kruskal Wallis test, Pearson correlation and linear regression analysis were used to determine the relationship between health-related quality of life with severity of the disease. Results: The mean score of symptoms, activity, impact and total on health-related quality of life score is 60.34±12.39, 27.53±2.78, 44.98±5.08 and 23.83±2.69, respectively.. There was statistically significant positive correlation between forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and FEV1/FVC and health-related quality of life score. After adjustment of covariate in regression analysis, the variables that predicted SGRQ scores in COPD patients are age (P-value <0.04), smoking (P-value <0.01) and spirometry values (FEV1 and FVC.) (P-value <0.05). The health-related quality of life scores were significantly different among mild, moderate severe disease patients (P-value <0.05). Conclusion: Among COPD patients, the health-related quality of life was impaired, and it has decreased as severity of disease increased. Proper management of disease and improved awareness among patients regarding factors which affect the health-related quality of life among COPD patients is necessary.
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Current Management of Gastrointestinal Stromal Tumor
Gautam Shubhankar, Rajdeep Singh, Manu Vats, D Abhilash Reddy, Naveen Kumar Solanki
January-April 2020, 6(1):1-6
Gastrointestinal stromal tumors (GISTs) are the commonest mesenchymal tumors of the gastrointestinal tract. The tumors originate from the interstitial cells of Cajal in the gastrointestinal tract. The tumor may present with a variety of different signs and symptoms, depending on the site and pathology of the tumor. Once the diagnosis is established, an aggressive and meticulous approach is required by the treating surgeon to eradicate the disease using multimodal therapy. Treatment of GIST is primarily surgical, with an adjunctive chemotherapy in the form of tyrosinase kinase inhibitors. The stagewise surgical and medical management of GIST will be discussed in this report. A Pubmed search, with relevant terms, was performed for selecting articles, collection of data and analysis for the compilation of this report. In this article, we attempt to outline the current approaches to the successful management of GISTs. The content of this article is based on available literature in print and Internet and experience in the management and treatment of patients with GIST at our institution.
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Whether Serum Glial Fibrillary Acidic Protein (GFAP) Can Be Used as a Diagnostic Biomarker in Patients With Glioblastoma?
Charandeep Singh Gandhoke, Ankit S Shah, Daljit Singh, Manju Subberwal, Rohit Kumar Gupta, Vinod Kumar Gupta, Ravindra K Saran
January-April 2020, 6(1):27-32
Aim: To study if there is an increase in the serum levels of Glial Fibrillary Acidic Protein (GFAP) in patients with glioblastoma so that it can be used as a diagnostic biomarker for these cases. Design: Prospective observational study. Material and Methods: We prospectively examined 193 patients, out of which 25 were controls (patients with degenerative spinal disease or CV junction anomaly), 79 were tumors other than glioma, 45 were histologically proven gliomas except glioblastoma and 44 were histologically proven glioblastomas. Serum was taken from the patients in the pre-operative period. Serum GFAP levels were determined using a biotin-labeled antibody-based sandwich enzyme immunoassay for the quantitative measurement of GFAP in ng/ml. Statistical Analysis: Data analysis was performed by using SPSS (Statistical Package for Social Sciences) version 20:0. Statistical significance was defined as P value < 0.05. Receiver operating characteristic (ROC) curve analysis was used to find the cut-off value of serum GFAP for glioblastoma patients. Results: In Group A (25 controls) and Group B (79 patients with non-glial brain tumors), no patient had detectable levels of GFAP in their serum. Out of the 45 patients with histologically proven gliomas except glioblastoma (Group C), 12 patients had raised serum GFAP levels. Out of the 44 patients with histologically proven glioblastomas (Group D), 38 patients had raised serum GFAP levels while in the remaining 6, the levels of serum GFAP were not detectable. The sensitivity of serum GFAP levels in diagnosing glioblastoma patients was 86.36% and the specificity was 91.95%. The diagnostic accuracy of the test was 90.67%. Conclusions: Serum GFAP is a sensitive and specific marker for glioblastoma and can be a useful pre-operative serum biochemical investigation in differentiating glioblastoma cases from other brain tumors.
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A Cross-sectional and Comparative Study of Attitude and Manner of Medical, Dental and Paramedical Students Towards Cadaveric Dissection
Lakshmi Venkata Simhacahalam Kutikuppala, Anirban Das Gupta, Kanna Sruthi, MV Sathvika
January-April 2020, 6(1):23-26
Background: Anatomy is the initial, basic and foundational subject of the medical and dental curriculum. It is thought to be the toughest subject in the initial days of the medical and dental course of study. This toughest subject is made little easier through practice of dissection. Objectives: The cardinal purpose of this study is to evaluate the attitude and manner of dissection, also to explore the views and perspectives towards cadaver and dissection among medical, dental and paramedical students. Methods: This is a cross-sectional study carried out at a reputed and well-recognised medical college. Study population is made of 546 students (medical, dental and paramedical students). They were given a well-prepared student questionnaire (made of 35 questions) and the responses were obtained and analysed. Results: Among 546 students (224 males and 322 females); 328 are MBBS, 127 are paramedical and 91 are BDS students. Four best questions were selected in the distributed questionnaire based on significance as P values, in which the question asked “Are you interested in cadaveric dissection” is extremely significant with a P value of 0.0092. Conclusions: Many of the students opted for the use of pre-dissected human specimens, instead of cadaveric dissection. They felt that dissection can help them to work as a team and improves their group discussion ability. Though most of the students are interested in cadaveric dissection, they touch the cadaver less often.
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Corona Virus Disease 2019 Outbreak: Action Plan for Risk Communication and Community Engagement
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
January-April 2020, 6(1):35-36
The Corona Virus Disease-2019 (COVID-19) outbreak, which originated in China has been declared as a Public Health Emergency of International Concern. Considering the fact that we are not very much certain about various epidemiological and causative virus attributes, it is quite obvious that a lot of myths and misconceptions will be spreading across the community. Thus, it is crucial to establish an action plan for risk communication and community engagement in already affected nations as well as those nations which are still not affected by the virus. In general, while formulating an action plan for the nations which have not yet reported any case of the disease, we predominantly concentrate on risk communication systems, coordination with different stakeholders, public communication, community engagement, capacity building and strategies to deal with prevailing myths & misconception about the disease. In conclusion, in the current COVID-19 outbreak, the risk communication and community engagement activities are critical components of the preparedness and response plan and all steps should be taken to strengthen the same for a better containment of the outbreak.
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Anaphylactic shock with intravenous furosemide: a rare undesired effect
Divya Gahlot, Rittick Talukdar, Vandana Seth, Manisha Manohar
January-April 2020, 6(1):60-62
Furosemide is a potent diuretic, with structural similarity to sulphonamide antibiotics. Its relative safety profile is one of the reasons to account for its widespread use. We report a rare case of fatal anaphylaxis with intravenous furosemide administered in our critical care settings for pulmonary edema. Chemical similarity of furosemide with sulphonamide antibiotics shares the possibility of similar allergic side effects. Thus, a more careful clinical use of furosemide, especially if administered intravenous should be kept in mind to avoid such catastrophic events.
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Successful pregnancy outcome in a multiparous lady with medical myriad-mixed connective tissue disorder, tuberculosis, chronic hypertension and recurrent pregnancy loss
Anjali Tempe, Tanuja Muthyala, Pushpa Mishra, Niharika Dhiman
January-April 2020, 6(1):54-59
Autoimmune diseases/mixed connective tissue disorders are chronic and complex group of disorders with multi-systemic involvement. Untreated cases have significant morbidity and poor quality of life. There is a T helper cell paradigm from T helper1 to T helper 2 in pregnancy and autoimmune diseases may flare or improve in pregnancy depending on the type of autoimmune disease and pre-conception disease activity. There is enough evidence to support that individuals affected with autoimmune diseases are susceptible to tuberculosis (TB) infection and conversely auto-antibodies like antinuclear antibody, and rheumatoid factor are detected in sera of patients with active tuberculosis. If this association applies in pregnancy and if immunosuppressive state of pregnancy would further augment this association is not reported. We report a rare case of a 40 year old multigravida with mixed connective tissue disorder (MCTD) with features of systemic lupus erythematosus, deforming rheumatoid arthritis with gangrenous changes and auto-amputation of toes. She had reactivation of TB in the index pregnancy. She was also a chronic hypertensive, hypothyroid and had recurrent pregnancy losses. Index pregnancy was following invitro fertilisation (IVF) conception with donor oocyte and was managed by a multidisciplinary team in obstetric high dependency unit and delivered a healthy baby; both mother and baby were discharged in stable condition. We report this case as there are no reports of MCTD with active TB in pregnancy and to review if pregnancy affects the course of MCTD, TB or association between these two, and management options in such high risk cases.
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Rare Entity of Sarcomatous Nodule Co-Existing With Benign Ovarian Tumour − A Case Report and Review of Literature
Poonam Sachdeva, Anamika Jain, Mannan Gupta
January-April 2020, 6(1):41-46
Coexistence of mural nodule with ovarian tumour is an extremely rare entity. We highlight the case of a 60 year old postmenopausal lady with a sarcomatous nodule co-existing with ovarian mucinous cystadenoma. She had presented with an abdominal mass increasing over 2 years associated with pain. Image and lab analysis showed a multiloculated cystic mass 40*30*12 cm with features suggestive of mucinous cystadenoma with borderline elevation of CA 125 - - 118. 4 IU/ml.. She underwent total abdominal hysterectomy with right sided ovariotomy with left salpigooopherectomy and infracolic omentectomy with bilateral pelvic lymph node sampling. Frozen section report showed cystic ovary with mucinous fluid with a 2.5 cm reddish mural nodule in its wall. Microscopic section showed mucin secreting columnar epithelium lining. Subepithelially, the nodule showed highly pleomorphic cells with large nucleus having corse chromatin 4–10 mitoses/hpf. Final histopathology report was suggestive of mucinous cystadenoma with malignant sarcomatous nodule. Following surgery she recieved 3 cycles of carboplatin, paclitaxel regimen chemotherapy and sustained well. On thorough review of literature, only 42 such cases of coexistence of malignant mural nodules with benign tumors have been found. Considering the malignant potential of such nodules they must not be overlooked and treated accordingly.
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Tubercular arthritis of elbow joint leading to radial nerve palsy: a rare presentation of a common disease
Ananya Sengupta, Neera Chaudhry, Cankatika Choudhury, Khushboo Gyanchandani
January-April 2020, 6(1):50-53
Tuberculosis of the elbow is a rare manifestation of musculoskeletal tuberculosis, accounting for only 2–5% of total number of cases. Peripheral neuropathy associated with tuberculosis is an even rarer phenomenon with very few cases described in literature, mainly involving either the ulnar nerve or the posterior interosseous nerve. This rarity of occurrence often leads to missed diagnoses. Here we present the case of a gentleman who had presented with tubercular arthritis of the elbow joint leading to radial nerve palsy. The diagnosis was established on the basis of elbow radiographs and Magnetic Resonance Imaging (MRI), nerve conduction studies and tru-cut biopsy of the synovium. The patient showed significant improvement with anti-tuberculous drug therapy.
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Corona Virus Disease 2019 Pandemic: Encouraging Involvement of Community Workers in the Active Search of Cases
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
January-April 2020, 6(1):39-40
In the ongoing Corona Virus Disease-2019 (COVID-19) pandemic, the role of health care professionals and outreach workers is indispensable towards the prevention and control of the disease. Anticipating the risk that the disease might land up into stage 3, a wide range of interventions have been implemented. However, the most important strategy will be to spread awareness about the disease and intensify actively search for the suspect cases in the community and here comes the role of outreach community workers. As the doctors and other paramedical staff are overwhelmed with the COVID-19 related work and are also involved in the delivery of emergency services, the importance of the role discharged by these community workers is extremely vital. In conclusion, the role of outreach community workers in creating awareness about COVID-19 and the identification of the suspect cases in the community through active search is extremely crucial in containing the disease and interrupting the chain of the transmission.
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Scope of informal assessments in the delivery of competency-based medical education
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
January-April 2020, 6(1):33-34
The process of assessment casts a significant positive influence-cum-motivation for the learners in any field of education, and the same applies to medical education as well. The assessments in each year of the academic course can be either formal or informal. For a significant period of time, only formal assessments have been given priority, while the informal assessments have been ignored. However, in the programmatic assessment and the assessments which has been proposed as a part of the newly introduced competency based undergraduate curriculum for the 2019 academic year, a significant weightage has been given to the informal assessments. In conclusion, amidst the paradigm shift from input-based to outcome-oriented competency-based education, the need of the hour is to reform the pattern of assessment and include informal assessments in the overall system to strengthen and validate the high-stakes decision and facilitate learning among the students.
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Sterile Insect Technique: The Future Strategy to Control Vector Mosquitoes and the Associated Diseases
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
January-April 2020, 6(1):37-38
The mosquito vector has been identified to play a vital role in a wide range of infectious diseases, most of which are associated with life threatening complications. For many decades, we have relied upon the employment of insecticides as the first line defense for the control of vector population, nevertheless owing to the reports of emergence of resistance to insecticides from different parts of the world and also due to the harmful impact of insecticides on the environment, the time has come where we look beyond them. The researchers from leading health agencies have advocated for strategies which can control the mosquito population itself and this will in turn minimize the risk of infection immensely. Sterile insect technique has been looked upon as the strategy for the control of vector population through birth control in the future. In conclusion, the approach of the sterile insect technique is a promising approach and has immense potential to ensure a reduction in the incidence of the mosquito vector and simultaneously respond to the problem attributed to insecticides.
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Gynaecological Catastrophe: Acute on Chronic Uterine Inversion − Can We Prevent It? A Case Report and Review
Tanuja Muthyala, Yedla Manikya Mala, Asmita Rathore, Sonia Goswami
January-April 2020, 6(1):47-49
In a non-obstetric patient, uterine inversion is a rare complication of intrauterine tumors. Till date, only 200 cases have been reported worldwide. The typical presentation is with features of haemorrhagic shock. Delay in diagnosis and management deteriorates the general health and future reproductive potential of the patient. We present a 30 year old multiparous lady, a diagnosed case of submucosal fibroid who had acute uterine inversion and was managed by performing a laparotomy with Haultains procedure. The case is bring presented as it is a rare gynaecological emergency, which requires immediate resuscitative and definitive procedures. Uterine conservation is a feasible option in selected cases of uterine inversion; chronic and neglected cases are a challenge for both conservative surgery and hysterectomy. High index of suspicion for malignancy should be a consideration irrespective of age, parity, previous benign conditions to optimize outcome.
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Management of Penetrating Arrow Neck Injury: A Report of Two Cases
Auwal Adamu, Yusuf Buka Ngamdu
January-April 2020, 6(1):63-67
Arrow neck injuries are rare in the developed countries due to development of modern firearms and ballistic missiles. However, they are still occuring in developing nations, due to incessant community clashes. Neck region houses the airway, the great vessels and other vital structures, any penetrating injury may result in devastating outcomes. The management can be challenging to even a well-trained surgeon especially in a resource limited center. Therefore, we present our experience in the management of penetrating arrow injury to the neck.
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Being ‘Mr Sensible’ while caring for severe traumatic brain injury (TBI) patients in ICU
Summit Dev Bloria
January-April 2020, 6(1):72-73
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Medicine and Science Versus Darwin
Summit Dev Bloria
January-April 2020, 6(1):68-69
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Generative Versus Retrieval-Based Learning Processes: Understanding the Enigma Behind Science of Learning for Better Teaching
V Dinesh Kumar, Raveendranath Veeramani
January-April 2020, 6(1):70-71
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