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   Table of Contents - Current issue
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May-August 2020
Volume 6 | Issue 2
Page Nos. 75-147

Online since Saturday, August 29, 2020

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REVIEW ARTICLE  

MRS Showing a Singlet Peak at 3.8 ppm in Three Patients with CNS Tuberculomas p. 75
Rahul S Ranjan, Namrata , Anil Singh, Swati Mody
DOI:10.4103/mamcjms.mamcjms_47_20  
Tubercular involvement of central nervous system is one of the common extrapulmonary manifestations of tuberculosis. MRI brain plays an important role in diagnosis of CNS tuberculomas. Most of the articles on MR spectroscopy of CNS tuberculomas have mentioned presence of lipid peak within it. However, few recent studies have mentioned presence of singlet peak at 3.8 ppm corresponding to Guanidinoacetate as more specific finding in CNS tuberculoma. Here we present Magnetic Resonance spectroscopy MRS findings of singlet peak at 3.8 ppm in three confirmed cases of CNS tuberculomas with review of literature.
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ORIGINAL ARTICLES Top

Biochemical Changes Using Sterile Water and 1.5% Glycine in TURP: A Randomized Study p. 81
Rajesh Meena, Haraesh Maranna, Lovenish Bains, Pawan Lal, Gaurish Sawant
DOI:10.4103/mamcjms.mamcjms_50_20  
Introduction: Endoscopic procedures in urology require irrigating fluid to provide a clear field of vision and to wash away debris. Glycine (1.5%) has been widely used, however sterile water is easily available and inexpensive. Excessive absorption of irrigation fluid can lead to dyselectrolytemia, hemolysis and systemic complications. In this study we compare 1.5% glycine with sterile water as irrigation fluid for Trans Urethral Resection Of Prostate (TURP). Materials and Method: In this prospective randomized study, we analysed 60 patients with symptomatic Benign Prostatic Hyperplasia (BPH) undergoing TURP with either 1.5% glycine or sterile water as irrigation fluid. The duration of surgery, weight of prostate resected, volume of fluid absorbed were compared. Post-operative levels of hemoglobin, hematocrit, electrolytes and renal function tests at 15 mins, 3 hrs and 6 hrs were analysed. Results: The mean decrease in hemoglobin at 6 hrs was more with 1.5% glycine (1.05±0.28 vs 0.89±0.14g/dL) and was statistically significant (P = 0.031). The mean fall in haematocrit at 6 hrs was significantly more with 1.5% glycine (4.87±1.41 vs 3.94±1.32%) (P = 0.046). The post-operative levels of blood urea were significantly less with 1.5% glycine at 15 mins, 3 hrs and 6 hrs (P < 0.05). There was no significant difference in the duration of surgery, weight of prostate resected, volume of irrigant absorbed, serum sodium, potassium and creatinine observed between the two groups (P > 0.05). Nine patients (30%) who received 1.5% glycine and 8 patients (26.6%) receiving sterile water had dilutional hyponatremia at 6 hrs, but there were no significant difference between the two groups (P = 0.38). None of the patients developed TURP syndrome. Conclusion: Biochemical changes with sterile water was significantly less when compared with 1.5% glycine in TURP. Most of the changes observed were at 6 hrs after surgery. Hence sterile water can be considered as a safer and inexpensive alternative to glycine in resource-limited settings of low-income countries.
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Public Perspective and Adherence to Government Directives in the Face of COVID-19 Situation in India p. 90
Rupsa Banerjee, Bratati Banerjee
DOI:10.4103/mamcjms.mamcjms_43_20  
Background: Coronavirus disease-19 (COVID -19) is an acute respiratory illness which spread rapidly to many countries including India. The Government of India took several measures to control the spread of the disease including issuing advisories and awareness materials for the public along with nationwide lockdown. Aims: To assess the public perspective of the disease, their behaviour during lockdown and adherence to government directives for its prevention. Materials and Method: A cross-sectional study was conducted among adult population residing in India during the lockdown, using a self-administered online-circulated questionnaire. Snowball sampling technique was followed. Data were collected on awareness regarding the disease and adherence to advisories issued by the government during the lockdown. Results: A total of 404 subjects sent their responses, of whom 73.76% were aged less than 50 years and 51.24% were females. More than 85% knew about the modes of spread of the disease and 97.5% knew its symptoms. Most participants were aware that they had to call the COVID-19 helpline number or visit a doctor/hospital immediately in case they came in contact with an infected person or developed symptoms themselves. Around 79% reported that they went out of their house during lockdown, mostly to buy essential supplies, of whom 8.7% went outside almost every day. More than 90% followed correct handwash practices but approximately 6% of those who went out didn’t use a mask regularly and 2% never used a mask. Conclusion: Majority of the participants across India were aware regarding COVID-19 and were following Government directives.
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Delayed Vaccination in Infants in an Urban Health Center in Delhi, India: Evidence from a Retrospective Audit of Secondary Data p. 97
Saurav Basu, Aditi Sajwan, Nidhi Bhatnagar
DOI:10.4103/mamcjms.mamcjms_20_20  
Background: Delayed vaccination in infants significantly increases the susceptibility window for vaccine preventable diseases. Objective: We conducted a retrospective audit of secondary data to determine the rates of delayed vaccination among infants reporting for routine immunization at an urban primary healthcare clinic in Delhi, India. Methods: Data were extracted from the manual register of the health clinic and entered in MS-Excel 2013. Results: We analyzed a total of 811 vaccination encounters in infants. Delayed vaccination was observed in 144 (17.8%) vaccination encounters. The proportion of delayed vaccination encounters progressively increased from penta-1 (lowest) to penta-3 (highest). However, the proportion of overall delayed vaccination encounters did not differ significantly across gender (P = 0.71). Conclusions: Delayed vaccination among infants continues to exist as a significant but largely avoidable public health challenge in certain health settings in India.
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Electroconvulsive Therapy: Knowledge and Attitudes Among Medical Interns and the General Public p. 100
Bilal Ahmad Bhat, Shabir Ahmad Dar, Arshad Hussain, Rouf Ahmad Mir
DOI:10.4103/mamcjms.mamcjms_6_20  
Background: Negative view of electroconvulsive therapy (ECT) is held not only by the general public, but also by the medical professionals. Aims: Aims were to assess the knowledge of ECT and attitude toward it in medical interns and general public. Materials and Method: This was a cross-sectional study in which knowledge of ECT and attitude toward this treatment were assessed in medical interns and general public using ECT knowledge and attitude questionnaire. A total of 36 participants from each group were included in the study. Results: Among the medical interns 75% reported the source of information as medical books whereas in general public 88.9% reported the primary source of information as media. Our participants from both groups were more knowledgeable about the consent, side effects, and procedure part of the questionnaire compared to other parts of it. The mean score for knowledge questionnaire was 16.58 ± 4.78 and 9.94 ± 4.82 for medical interns and general public respectively (t = 3.74; P = 0.001). The mean score on attitude questionnaire was 9.94 ± 4.82 and 0.83 ± 8.56 for medical interns and general public, respectively (t = 5.56; P = 0.0001). In both medical interns and general public, total score on knowledge questionnaire and total score on attitude questionnaire were correlated positively (rs = 0.542, P < 0.001 and rs = 0.446, P < 0.006 respectively). Conclusion: our study found a low knowledge of ECT in general public with less favorable attitude toward this treatment. With a good knowledge of ECT and more favorable attitude in medical students, still there are lacunae in them. However, in both these groups, there was a positive correlation between knowledge and favorable attitude.
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A Cross-Sectional Study Evaluating Inflammatory Markers in Hemophilia and Association with Chronic Complications p. 107
Sunita Aggarwal, Sanjay Kumar, Naresh Gupta, Sandeep Garg, Anita Chakravarty, Pranav Ish, Jahnvi Dhar
DOI:10.4103/mamcjms.mamcjms_95_19  
Introduction: Inflammatory markers in hemophilia have been implicated in various bleeding-related complications such as hemarthrosis and muscle hematoma causing damage to the joints and muscle and overt bleeding episodes. Materials and Method: This cross-sectional study included 30 patients of hemophilia with acute bleeding episode (less than 48 hours) and 30 patients in non-bleeding group (more than 2 weeks). Hemoglobin, leucocyte count, platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum albumin, serum fibrinogen, serum ferritin, serum lactate dehydrogenase (LDH), tumour necrosis factor alpha (TNF-α) and IL 1β levels in all the subjects was measured and a correlation was sought between the two groups and with the complications of the disease. Results: ESR, CRP, Fibrinogen, LDH, Ferritin, TNF-α and Interleukin (IL)-1β was higher in acute Bleeder group as compared to Non-bleeder group. The hemophilic patients with joint deformity had elevated ESR and IL-1β. Conclusion: In hemophilia patients, CRP, ESR, Fibrinogen, Ferritin, LDH, IL-1β and TNF-α may have a role as an acute bleeding marker. ESR and IL 1 beta may be markers of arthropathy in hemophilia suggesting that inflammation may have a vital role in hemophilic arthropathy.
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Study of the Clinical, Electrocardiographic and Biochemical Spectrum of Cardiovascular Complications in Patients With Aneurysmal Subarachnoid Hemorrhage − An Initial Experience at a Tertiary Centre in India p. 113
Charandeep Singh Gandhoke, Simran Kaur Syal, Robin Harshvardhan Gupta, Daljit Singh, Jitender Sharma, Bhawna Mahajan, Monica Tandon, Vijay Kumar Trehan, Ankit Bansal
DOI:10.4103/mamcjms.mamcjms_77_19  
Objectives: Aneurysmal subarachnoid hemorrhage (SAH) is an extremely fatal condition with mortality as high as 45%. Apart from the intra-cranial causes, there are cardiovascular events, which add to the morbidity and mortality. These can manifest with deranged cardiac biomarkers. However, quantitative assessment of these biochemical markers and its correlation with prognosis has not been adequately studied. We tried to analyse the spectrum and outcome of cardiovascular complications in patients with aneurysmal SAH and whether elevated levels of serum biochemical markers have any association with the prognosis. Study Design: Prospective observational study. Materials and Method: We included patients of all grades of aneurysmal SAH with ictus less than 48 hours at the time of admission. The patient’s serum biochemical marker levels [troponin T (TnT), total creatine phosphokinase (CPK), cardiac-specific creatine phosphokinase (CPK − MB), brain natriuretic peptide (BNP) and C reactive protein (CRP)] were measured for 6 consecutive days from the day of admission (Day 0). Patient also underwent 12 lead Electrocardiography (ECG) and two dimensional echocardiography (2D Echo) on Day 0, Day 1 and Day 5. Statistical Analysis: Data analysis was performed by using Statistical Package for Social Sciences (SPSS) version 20:0. Chi-square test and Fisher’s exact test were used to find the association between diagnosis and various data variables associated with diagnosis. P value less than 0.05 was considered as significant. Data was graphically depicted with the help of box plots. Receiver Operating Characteristic (ROC) curves were plotted for TnT, CPK and BNP. Results: Twenty five patients were enrolled in the study. Out of the five serum biochemical markers studied, TnT, CPK and BNP were statistically associated with outcome. Serum TnT levels on day 4; serum CPK levels on day 3 and day 4; and serum BNP levels on day 3, day 4 and day 5 were statistically significant. BNP was the serum biochemical marker which had the strongest statistical association with outcome. ECG abnormalities were observed in 76% of the cases. Prolonged corrected QT (QTc) interval was the most common abnormal ECG finding among the patients who died. One patient developed 3rd degree heart block and another patient developed left ventricular dysfunction with an ejection fraction of 40% on 2D Echo following aneurysmal SAH. Conclusion: Cardiovascular complications are common in patients with aneurysmal SAH. Serum quantitative levels of TnT, CPK and BNP can be incorporated in the battery of routine blood tests in SAH patients for predicting outcome.
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SHORT COMMUNICATION Top

Corona Virus Disease 2019 Pandemic: The Necessity for Outbreak Readiness and Response Plan in Prison Settings p. 121
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mamcjms.mamcjms_21_20  
The pandemic of Corona Virus Disease-2019 (COVID-19) has overwhelmed the health care delivery system and compelled the public health authorities to mount an unprecedented response against the novel viral infection. People who are deprived of their freedom and who are residing in prison or other detention centers, usually stay in close proximity and therefore there is a definite possibility that they can be a source of infection or multiplication and thus play an important role in the transmission of this viral infection within and beyond the prison settings. Thus, there is a definite need for each of the nation to improve their outbreak readiness and response system to identify and manage the cases of the disease in prison settings. In conclusion, in the ongoing battle against COVID-19 pandemic, the health and safety of people in prison cannot be ignored, as there is a definite possibility for the introduction and amplification of the disease in the prison as well as in the community
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Strengthening infection prevention and control services in the long-term care facilities amidst fighting against Corona Virus Disease 2019 pandemic p. 123
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mamcjms.mamcjms_23_20  
The ongoing Corona Virus Disease-2019 (COVID-19) pandemic has influenced the lives of everyone, regardless of the fact that whether they are part of the general community or a vulnerable population groups and are living in campsites or in conflict areas or even in long-term care facilities (LTCF). In general, LTCFs are usually overcrowded and thus the possibility of rapid transmission of infection cannot be ruled out. Infection prevention and control has been acknowledged as the key strategy to prevent the causative virus from entering or spreading within the facilities and also to prevent its transmission outside these facilities. In conclusion, in the fight against the COVID-19 pandemic, it is extremely important to safeguard the health of vulnerable population groups in long-term care facilities through strengthening of the infection prevention and control strategies.
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Exposing undergraduate medical students to inter-professionalism education in the competency-based curriculum p. 125
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mamcjms.mamcjms_89_19  
The field of medicine has been regarded as one of the most complex fields requiring inputs from a number of stakeholders for a favorable outcome of a patient. Acknowledging this, it is the need of the hour to expose the medical students to the concept of inter-professional education (IPE) right from the initial stages of their career. The context to initiate IPE usually results whenever there is a desire to ameliorate health outcomes of the patients or to improve the health care delivery practices. At the same time, the time allocated for the electives after the completion of third professional year can also be utilized to run a complete module or training on any inter-professional course. In conclusion, an approach of inter-professional education is a must to ensure the delivery of effective and efficient health care, including the domains of enhancing patient safety through optimal utilization of the skills of each professional.
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CASE REPORTS Top

Cystic Gastrointestinal Tumors: An Unusual Imaging Appearance − A Case Series p. 128
Radhika Batra, Surabhi Gupta, Anjali Prakash, Lalendra Upreti, Sapna Singh
DOI:10.4103/mamcjms.mamcjms_30_20  
Gastrointestinal stromal tumors (GISTs) are commonly seen mesenchymal tumors of stomach and digestive tract. Morphologically they show similarities to other tumor types and were previously misclassified as leiomyomas, leiomyoblastomas, or leiomyosarcomas. GISTs are typically solid tumors with larger tumors showing areas of necrosis and rarely present with predominantly cystic changes. Here we report three cases of GISTs with predominant cystic component. Cystic GISTs although rare, should be considered as part of differential diagnosis for large intra-abdominal cystic lesions. Immunohistochemistry is critical for final diagnosis.
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Cystic Adventitial Disease of the Popliteal Artery : A Rare Case with Review of Literature p. 135
Ayush Jain, Shilpa S Sankhe, Dinesh M Sontakke
DOI:10.4103/mamcjms.mamcjms_15_20  
Cystic adventitial disease (CAD) is a rare non-atheromatous affection of the popliteal artery, often misdiagnosed, leading to increasing morbidity and eventual disability. More commonly unilateral, this condition tends to affect males in their fourth and fifth decades. Diagnosis is usually suggested with ultrasonography (USG) and is further confirmed with digital subtraction angiography (DSA). Magnetic resonance imaging (MRI) angiography is another non-invasive method for diagnosis of CAD. Where DSA gives information about the luminal contour and severity of narrowing, MRI helps in evaluation of the extramural component and surrounding soft tissue. Management is in the form of resection of the involved popliteal artery segment.
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Weight Regain After LABG: Ponder to Intra-gastric Migration of Adjustable Gastric Band p. 139
Lovenish Bains, Pawanindra Lal, Anubhav Vindal, Kamal Kishore Gautam
DOI:10.4103/mamcjms.mamcjms_78_19  
Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive bariatric procedure. However troublesome complications can arise later with this procedure including band slippage and erosion. Intra-gastric erosion is a rare but major bothersome late complication after LAGB and requires band removal. A 35-year-old lady with BMI of 45.03 and hypertension as co-morbidity opted for LAGB. The patient started losing significant weight, however patient noticed sero-purulent discharge from epigastric port site after three months. Investigations were not suggestive of any leak, but persistent discharge led to wound exploration and infected band tubing was removed. The patient again noticed discharge from the port site after 20 months of primary surgery along with weight regain. Oral gastrograffin study was performed, which showed no evidence of contrast leak, however band seemed lower in position. Upper gastrointestinal (UGI) endoscopy showed a part of circumference of the band in the gastric cavity confirming intra-gastric migration and not retrieved due to adhesions with gastric wall. The band was removed by laparoscopic converted to open procedure due to dense adhesions. The patient recovered well. Migration of the band through the stomach wall is an uncommon late complication that may remain asymptomatic but must be thought in presence of weight regain or port-related complications. UGI endoscopy is diagnostic and therapeutic in most cases, rest of the cases require laparoscopy or laparotomy for band removal, depending upon surgeon or endoscopist expertise.
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LETTER TO THE EDITOR Top

What We Need to Consider While Combating COVID 19 in Paediatric Population is Different From Adults? Preliminary Analysis of Literature p. 143
Shuriya Prabha M., Dinesh Kumar. V.
DOI:10.4103/mamcjms.mamcjms_34_20  
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“There’s always a First Time”: My experience in COVID ICU as “Corona warrior” p. 145
Amol Bansal, Lalit Gupta
DOI:10.4103/mamcjms.mamcjms_60_20  
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